Preferred Drug List (PDL) and Pharmacy Quarterly Update
Dec 8, 2025 - Effective January 1, 2026, the Alabama Medicaid Agency (Medicaid) will:
(1)Require prior authorization (PA) for glycerol phenylbutyrate (generic Ravicti). Brand Ravicti will not require a PA and will be billed with a Dispense as Written (DAW) Code of 9. (2) Require prior authorization for clemastine syrup (generic Tavist), conjugated estrogens tablets (generic Premarin tablets), fluticasone/vilanterol (generic Breo Ellipta), and mirabegron (generic Myrbetriq). Brand Breo Ellipta, Myrbetriq, and Premarin tablets will be preferred and will be billed with a DAW Code of 9.
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Radiology Prior Authorization Changes
Dec 5, 2025 - Effective January 1, 2026, the Alabama Medicaid Agency (Medicaid) will remove the prior authorization requirement for various procedures.
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Changes to Non-Pharmacy Prior Authorization Process
Dec 5, 2025 - Beginning January 1, 2026, the Alabama Medicaid Agency (Medicaid) will implement changes to the prior authorization (PA) process for non-pharmacy PAs to comply with the CMS Interoperability and Prior Authorization Final Rule. This Final Rule does not apply to pharmacy PA requests.
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REVISED - Continuous Glucose Monitor Policy Updates
Dec 2, 2025 - Effective October 1, 2025, Continuous Glucose Monitors (CGMs) will be covered through the Durable Medical Equipment (DME) Program with prior authorization (PA) for recipients (children and adults) with one of the following: type 1 diabetes mellitus; type 2 diabetes mellitus or gestational diabetes AND are insulin treated with multiple (three or more) daily injections of insulin.
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