Physicians who help the state of Alabama save money by using Medicaid’s Preferred Drug List (PDL) are now being recognized by a new program that exempts them from many of the Agency’s prior authorization (PA) requirements. 

The Gold Standard program was launched April 1 to recognize prescribers whose compliance rate with the Agency’s PDL is in the top 3 percent or higher, according to Pharmacy Services Director Kelli Littlejohn, Pharm.D.  To qualify as a Gold Standard prescriber, physicians had to have three or fewer non-preferred drug claims and more than 220 prescriptions for preferred or over-the-counter drugs written during the previous quarter.  Based on fourth quarter 2010 data, 345 prescribers were designated as “gold standard” providers for the April-June 2011 quarter.

Gold Standard providers are exempt from certain prior authorization requirements for a specified time.  During that time period, most non-preferred prescriptions written by the provider will be approved at the pharmacy and will not require that a PA request form be submitted and approved before the prescription can be filled. Certain drugs are excluded from the exemption and still require a PA, including monoclonal antibodies, PDE inhibitors, weight loss agents, growth hormones and biological injectibles.

Providers are re-evaluated each quarter, and once a provider has been on the Gold Standard list for three of four quarters, the exemption stretches to one year. Providers who do not meet the “gold standard” will continue to use the usual request process when prescribing a drug that requires prior authorization.

In Fiscal Year 2010, more than 8.6 million prescriptions were dispensed at a cost of more than $514 million. The Agency’s Preferred Drug List was started in 2003 to help keep health care costs down by encouraging use of preferred, generic and over-the counter drugs.  

“A 2010 study found that implementation of a mandatory PDL saved the state more than $275 million between November 2003 and December 2009,” Dr. Littlejohn said. “This validates our experience that the PDL results in cost savings while supporting quality health care.”