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TO: Pharmacies, Physicians, Physician Assistants, Nurse Practitioners,
Oral Surgeons, Optometrists, Dentists, FQHCs, RHCs, Mental Health Service
Providers and Nursing Homes
RE:
Preferred Drug List (PDL) and Pharmacy Quarterly
Update
Effective
April 1, 2026, the Alabama Medicaid Agency (Medicaid) will:
- Remove
the Dispense as Written (DAW) Code of 9 from Adderall XR, Toujeo, and
Xarelto.
- Update
the PDL to reflect the quarterly updates listed below:
CC This agent will be
preferred with clinical criteria in place.
- Add Journavx as
preferred on the PDL with clinical criteria. Clinical criteria consist
of an allowance for up to a 14-day supply every 90 days for recipients 18
years of age and older through the electronic prior authorization (PA)
system, with no manual PA required. Requests outside of clinical criteria
guidance will require manual PA.
For additional PDL and
coverage information, visit our drug look-up site at
https://www.medicaid.alabamaservices.org/alportal/NDC%20Look%20Up/tabId/5/Default.aspx.
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 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:
Acentra Health
Medicaid Pharmacy Administrative Services
P.O. Box 3570, Auburn, AL 36831
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 Acentra Health. Additional information
may be requested. Staff physicians will review this information.
The Current Procedural
Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and
other data are copyright © 2026 American Medical Association
and © 2026 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.