Alerts

Preferred Drug List (PDL) Quarterly Update

6/4/2019

PDF Version


TO:  Pharmacies, Physicians, Physician Assistants, Nurse Practitioners,

        Oral Surgeons, Optometrists, Dentists, FQHCs, RHCs, Mental Health

        Service Providers and Nursing Homes


Effective July 1, 2019 the Alabama Medicaid Agency will:

 

1.    Remove Prior Authorization (PA) from dexmethylphenidate IR (generic Focalin) and dextroamphetamine/amphetamine ER (generic Adderall XR). Brand Focalin and brand Adderall XR will now require PA.

 

2.    Include the Calcitonin Gene-Related Peptide Receptor Antagonists (Antimigraine 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.

 

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


PDL Additions

Aimovigcc

CGRP Receptor Antagonists (Antimigraine Agents)

Buprenorphine/Naloxone Tabletscc

Opiate Partial Agonists

Dexmethylphenidate IR

ADHD Agents

Dextroamphetamine/Amphetamine ER

ADHD Agents

Emgalitycc

CGRP Receptor Antagonists (Antimigraine Agents)

Kombiglyze XR

Dipeptidyl Peptidase-4 Inhibitors

Ledipasvir-Sofosbuvircc

HCV Antivirals

Onglyza

Dipeptidyl Peptidase-4 Inhibitors

Sofosbuvir-Velpatasvircc

HCV Antivirals

Sublocadecc

Opiate Partial Agonists

PDL Deletions

Adderall XR

ADHD Agents

Citranatal 90 DHA

Prenatal Vitamins

Citranatal Assure

Prenatal Vitamins

Citranatal B-Calm

Prenatal Vitamins

Citranatal DHA

Prenatal Vitamins

Citranatal Harmony

Prenatal Vitamins

Citranatal Rx

Prenatal Vitamins

Focalin

ADHD Agents

                       cc Indicates drug will be preferred with clinical criteria.


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 © 2019 American Medical Association and © 2019 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.