December 9, 2015

State of Alabama
Press Release: Medicaid

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 January 1, 2016, the Alabama Medicaid Agency will:


1.          Include additional drugs in the mandatory three-month maintenance supply program.  Drugs include additional preferred antidepressants, preferred alpha blockers and generic isosorbide tablets and nitroglycerin patches.  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.          Update the Preferred Drug List (PDL) to reflect the quarterly updates. The updates are listed below: 

PDL Additions

Anoro Ellipta

Respiratory Beta-Adrenergic Agonists


EENT-Antiallergic Agents

Provida DHA

Prenatal Vitamins


Intranasal Corticosteroids

QNASL Children

Intranasal Corticosteroids

PDL Deletions

Beconase AQ

Intranasal Corticosteroids







Humalog Mix 50-50


Humalog Mix 75-25






Synagis® Update:

Effective 1/1/2016, Synagis® must be prescribed through a pharmacy.  Allowances were made during the beginning of the 2015-2016 season for prescribers' offices to directly bill CPT code 90378 and utilize existing stock; however, CPT code 90378 will be discontinued effective 1/1/2016.


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


The PA request form and criteria booklet, as well as a link for a PA request form that can be completed and submitted electronically online, can be found on the Agency’s website at and should be utilized by the prescriber or the dispensing pharmacy when requesting a PA. 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.


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