TO: Pharmacies, Physicians,
Physician Assistants, Nurse Practitioners, Oral Surgeons, Optometrists,
Dentists, FQHCs, RHCs, Mental Health Service Providers and Nursing Homes
Effective January 1, 2020, the Alabama Medicaid
Agency will:
1.
Remove methotrexate tablets from the
mandatory three-month supply program.
2.
Update the PDL to reflect
the quarterly updates. The updates are listed below:
PDL Additions
|
None
|
None
|
PDL Deletions
|
Zontivity
|
Platelet Aggregation
Inhibitors
|
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 Prior
Authorization (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 https://medicaid.alabama.gov/content/9.0_Resources/9.4_Forms_Library/9.4.13_Pharmacy_Forms.aspx.
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.