TO: Pharmacies, Physicians, Physician Assistants, Nurse Practitioners, Oral Surgeons, Optometrists, Dentists, FQHCs, RHCs, Mental Health Service Providers, and Nursing Homes
Effective October 1, 2018, the Alabama Medicaid Agency will:
1. Include preferred insulins 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 generic hydroxyprogestrone injection (generic Makena). Brand Makena will not require prior authorization.
Use Dispense as Written (DAW) Code of 9 for brand Makena. 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. Update the PDL to reflect the quarterly updates. The updates are listed below:
PDL Additions
|
Cotempla XR
|
Agents used for ADHD
|
Darifenacin (generic Enablex)
|
Genitourinary Smooth Muscle Relaxants-Antimuscarinics
|
Moxifloxacin Drops (generic Vigamox)
|
EENT- Antibacterials
|
Olopatadine (generic Patanase)
|
EENT- Antiallergic Agents
|
Quillichew
|
Agents used for ADHD
|
Qvar Redihaler
|
Respiratory Corticosteroids
|
Vesicare
|
Genitourinary Smooth Muscle Relaxants-Antimuscarinics
|
Zontivity
|
Platelet Aggregation Inhibitors
|
PDL Deletions
|
Adzenys
|
Agents used for ADHD
|
Enablex
|
Genitourinary Smooth Muscle Relaxants-Antimuscarinics
|
Patanase
|
EENT- Antiallergic Agents
|
Strattera
|
Agents used for ADHD
|
Vigamox
|
EENT- Antibacterials
|
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
http://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.
The Current Procedural Terminology (CPT) and Current Dental Terminology
(CDT) codes descriptors, and other data are copyright © 2018 American Medical
Association and © 2018 American Dental Association (or such other date publication of CPT
and CDT). All rights reserved. Applicable FARS/DFARS apply.