Alerts

Preferred Drug List (PDL) Quarterly Update

3/13/2018

PDF Version

  

TO:       Pharmacies, Physicians, Physician Assistants, Nurse Practitioners, Oral Surgeons  Optometrists, Dentists, FQHCs, RHCs, Mental Health Service Providers and Nursing Homes

 

 

Effective April 1, 2018 the Alabama Medicaid Agency will:

 

1.          Update the PDL to reflect the quarterly updates. The updates are listed below: 

 

PDL Additions

Alvesco

Orally Inhaled Corticosteroids

Asmanex HFA

Orally Inhaled Corticosteroids

Citranatal Bloom

Prenatal Vitamins

Ezetimibe (generic Zetia)

Cholesterol Absorption Inhibitors

Flovent Diskus

Orally Inhaled Corticosteroids

Flovent HFA

Orally Inhaled Corticosteroids

Nasonex

Intranasal Corticosteroids

Pulmicort Flexhaler

Orally Inhaled Corticosteroids

Seebri

Inhaled Antimuscarinic

Symbicort

Orally Inhaled Corticosteroids

Tudorza

Inhaled Antimuscarinic

Xopenex HFA

Respiratory Beta Agonists

Zetonna

Intranasal Corticosteroids

Zyflo CR

Leukotriene Modifiers

PDL Deletions

Levalbuterol HFA (generic Xopenex HFA)  

Respiratory Beta Agonists

Qnasl

Intranasal Corticosteroids

Qnasl Children

Intranasal Corticosteroids

Qvar

Orally Inhaled Corticosteroids

Zetia

Cholesterol Absorption Inhibitors

Zileuton ER (generic Zyflo CR)

Leukotriene Modifiers

          

 

For additional PDL and coverage information, visit our drug look-up site at https://www.medicaid.alabamaservices.org/ALPortal/NDC%20Look%20Up/tabId/39/Default.aspx.

 

 

The PA request form and criteria booklet, as well as a link for a PA request form that can be completed and submitted electronically online, can be found on the Agency’s website at www.medicaid.alabama.gov and should be utilized by the prescriber or the dispensing pharmacy when requesting a PA. Providers requesting PAs by mail or fax should send requests to:

 

Health Information Designs (HID)

Medicaid Pharmacy Administrative Services

P. O. Box 3210 Auburn, AL 36832-3210

Fax: 1-800-748-0116

Phone: 1-800-748-0130

 

Incomplete PA requests or those failing to meet Medicaid criteria will be denied. If the prescriber believes medical justification should be considered, the prescriber must document this on the form or submit a written letter of medical justification along with the PA form to HID. Additional information may be requested. Staff physicians will review this information.

 

Policy questions concerning this provider notice should be directed to the Pharmacy Program at (334) 242-5050. Questions regarding PA procedures should be directed to the HID help desk at 1-800-748-0130.

 

 

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2018 American Medical Association
and © 201
8 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.