Alerts

Preferred Drug List (PDL) Quarterly Update

6/10/2020

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, 2020 the Alabama Medicaid Agency will:

 

1.    Remove prior authorization (PA) from Mometasone nasal spray (generic Nasonex) and Modafinil (generic Provigil). Brand Nasonex and Provigil will now require PA.

 

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

PDL Additions

Anoro Ellipta

Respiratory Beta Agonists

Bevespi

Respiratory Beta Agonists

Buprenorphine/Naloxone TabletsCC

Opiate Partial Agonists

Combivent

Respiratory Beta Agonists

Modafinil

Wakefulness Promoting Agents

Mometasone Nasal Spray

Intranasal Corticosteroids

Striverdi Respimat

Respiratory Beta Agonists

PDL Deletions

Dymista

Intranasal Corticosteroids

Emgality

CGRP Receptor Antagonists (Antimigraine Agents)

Moxeza

EENT Antibacterials

Nasonex

Intranasal Corticosteroids

Provigil

Wakefulness Promoting Agents

Vesicare

Genitourinary Antimuscarinic

                 CC 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 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.