TO: Pharmacies, Physicians, Physician
Assistants, Nurse Practitioners, Oral Surgeons, Optometrists, Dentists, FQHCs,
RHCs, Mental Health Service Providers and Nursing Homes
Effective
November 19, 2018
- Add Xofluza® to the PDL as a preferred agent.
In
anticipation of the upcoming flu season and the FDA-approval of Xofluza®
on October 24th, the P&T Committee made an ad hoc recommendation
during the November 7th meeting. The Committee recommended to follow
the Centers for Disease Control and Prevention (CDC) statewide influenza
epidemiology status for all available FDA-approved influenza antivirals
(including Xofluza®) as soon as is possible to have the agents
available for the upcoming flu season.
Therefore, Xofluza® was added to preferred status prior to
the January 1, 2019, PDL update.
Effective
January 1, 2019, the Alabama Medicaid Agency will:
- Require Prior Authorization (PA) for ritonavir (generic Norvir). Brand Norvir will not require prior
authorization.
Use
Dispense as Written (DAW) Code of 9 for brand Norvir. 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.
- Update the PDL to reflect the quarterly
updates. The updates are listed below:
PDL Additions
|
ZubsolvCC
|
Opiate Partial Agents
|
EucrisaCC
|
Skin and Mucous Membrane,
Anti-Inflammatory Agents
|
CC Preferred with Clinical
Criteria
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
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.