March 3, 2020

State of Alabama
Press Release: Medicaid

Preferred Drug List (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 April 1, 2020, the Alabama Medicaid Agency will:


1.    Remove prior authorization from Tobramycin-Dexamethasone Ophthalmic Solution (generic Tobradex). Brand Tobradex will now require PA.


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


 PDL Additions


Incretin Mimetics


Beta Blockers


Beta Blockers

Incruse Ellipta

Inhaled Antimuscarinics

Stiolto Respimat

Respiratory Beta Agonists

       Tobramycin-Dexamethasone Ophth. Solution

EENT Antibacterials


Incretin Mimetics

PDL Deletions

Proventil HFA

Respiratory Beta Agonists

Seebri Neohaler

Inhaled Antimuscarinics


EENT Anitbacterials

                 CC Preferred with Clinical Criteria


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


The Prior Authorization (PA) request form and criteria booklet should be utilized by the prescriber or the dispensing pharmacy when requesting a PA. The PA request form can be completed and submitted electronically on the Agency’s website at



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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