Preferred Drug List (PDL) Quarterly Update


PDF Version


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


 Effective October 1, 2019, the Alabama Medicaid Agency will:


1.    Include preferred fibric acid derivatives, alendronate tablets, amitriptyline tablets, azathioprine tablets, hydroxychloroquine tablets, methotrexate tablets, pioglitazone tablets, and trazodone tablets in the mandatory three-month supply program.

Prescriptions for three-month maintenance supply medications will not count toward the monthly prescription limit. A maintenance supply prescription will be required after 60 days’ stable therapy. Please see the website for a complete listing of maintenance supply medications.


2.    Include the Antigout Agents in the Preferred Drug List (PDL). 


3.    Require Prior Authorization (PA) for colchicine tablets.


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

PDL Additions

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


Sodium-glucose Cotransport 2 Inhibitors

Humalog Mix



Sodium-glucose Cotransport 2 Inhibitors


Sodium-glucose Cotransport 2 Inhibitors


Sodium-glucose Cotransport 2 Inhibitors


Dipeptidyl Peptidase-4 (DPP-4) Inhibitors






Dipeptidyl Peptidase-4 (DPP-4) Inhibitors

PDL Deletions




Scabicides and Pediculicides



For additional PDL and coverage information, visit our drug look-up site at


The PA request form and criteria booklet should be utilized by the prescriber or the dispensing pharmacy when requesting a PA. The PA request form can be completed and submitted electronically on the Agency’s website at


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.