September 9, 2016

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 October 1, 2016, the Alabama Medicaid Agency will:

1.  Include folic acid tablets in the mandatory three-month maintenance supply program
.  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.  Require prior authorization (PA) for payment of olopatadine nasal spray (generic Patanase). Brand Patanase will be preferred without PA.
Use Dispense as Written (DAW) Code of 9 for brand Patanase. DAW Code of 9 indicates the following: Substitution Allowed by Prescriber but Plan Requests Brand. This value is used when the prescriber has indicated, in a manner specified by prevailing law, that generic substitution is permitted, but the Plan requests the brand product to be dispensed.

3.  Remove prior authorization from lidocaine patches (generic Lidoderm). Brand Lidoderm will now require PA.

4.  Remove prior authorization from tobramycin inhalation solution (generic Tobi). Brand Tobi will now require PA.

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

PDL Additions

 

Besivance

EENT Antibacterial Agents

 

Blephamide

EENT Antibacterial Agents

 

Cortisporin-TC

EENT Antibacterial Agents

 

Levemir

Insulins

 

lidocaine patches (generic)

Skin and Mucous Membrane Agents-Antipruritics

 

Moxeza

EENT Antibacterial Agents

 

Patanase

EENT Antiallergic Agents

 

Pazeo

EENT Antiallergic Agents

 

tobramycin inhalation solution (generic)

Aminoglycosides

 

 

Vigamox

EENT Antibacterial Agents

 

ZepatierCC

HCV Antivirals

 

Zylet

EENT Antibacterial Agents


cc Preferred with Clinical Criteria



The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2016 American Medical Association
and © 2016 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.
             

 

PDL Deletions

Combivent

Respiratory Beta-Adrenergics

Lidoderm Patches

Skin and Mucous Membrane Agents -Antipruitics

Mentax

Skin and Mucous Membrane Agents -Antifungals

metformin ER (generic of brand Fortamet ER and Glumetza ER)

Biguanides

ofloxacin otic drops (generic)

EENT Antibacterials

olopatadine nasal spray (generic)

EENT Antiallergic Agents

Pataday

EENT Antiallergic Agents

Tobi

Aminoglycosides

cc Preferred with Clinical Criteria


The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2016
American Medical Association and © 2016 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.



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 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 www.medicaid.alabama.gov 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.


  • For more information, visit http://medicaid.alabama.gov
  • For more state-wide press releases, click here