Alerts

Preferred Drug List (PDL) Quarterly Update

3/12/2019

PDF Version


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

 

RE:     Preferred Drug List (PDL) Quarterly Update

 

Effective April 1, 2019 the Alabama Medicaid Agency will:

 

1.    Require Prior Authorization (PA) for generic tobramycin/dexamethasone ophthalmic drops, generic albuterol HFA, and generic fluticasone/salmeterol inhalation device. Brand Tobradex and Advair Diskus will be added as preferred.  Brand Proair HFA and Proventil HFA will remain preferred.   

Use Dispense as Written (DAW) Code of 9 for brand Tobradex, Proair HFA, Proventil HFA, and Advair Diskus. DAW Code of 9 indicates the following: Substitution Allowed by Prescriber but Plan Requests Brand. This value is used when the prescriber has indicated, in a manner specified by prevailing law, that generic substitution is permitted, but the Plan requests the brand product to be dispensed.

 

2.    Remove prior authorization from budesonide respules (generic Pulmicort)Brand Pulmicort Respules will now require PA.

 

3.    Include the Growth Hormone Agents in the Preferred Drug List (PDL).  Preferred agents will be preferred with clinical criteria.

Preferred products will require a prior authorization request be submitted. Clinical criteria must be met in order to be approved.  Non-preferred products will require prior authorization; for a non-preferred product to be approved, failure with a designated number of preferred agents and clinical criteria must be met.

 

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

 

PDL Additions

Advair Diskus

Inhaled Corticosteroids Agents

Advair HFA

Inhaled Corticosteroids Agents

Budesonide (generic Pulmicort Respules)

Inhaled Corticosteroids Agents

Dulera

Inhaled Corticosteroids Agents

Omnitropecc

Growth Hormone Agents

Tobradex Ophthalmic Drops

EENT Antibacterial Agents

Xifaxan

Miscellaneous Antibacterial Agents

Zomactoncc

Growth Hormone Agents

PDL Deletions

Albuterol HFA (generic Proair HFA and Ventolin HFA)

Respiratory β-Agonists

Alvesco

Inhaled Corticosteroids Agents

Cotempla XR

ADHD Agents

Fluticasone/salmeterol inhalation device (generic Advair Diskus)

Inhaled Corticosteroids Agents

Kapvay*

ADHD Agents

Pulmicort Respules

Inhaled Corticosteroids Agents

   Tobramycin/Dexamethasone Ophthalmic Drops (generic Tobradex)

EENT Antibacterials

                              cc Indicates drug will be preferred with clinical criteria.

                              * Drug was non-covered effective 1/28/2019.

 

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.