February 22, 2021

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, 2021, the Alabama Medicaid Agency will:

Require a Prior Authorization (PA) for pimecrolimus cream (generic Elidel cream). Brand Elidel cream will remain preferred.

Require Elidel cream to be billed with a Dispense as Written (DAW) Code of 9: 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

No additions

PDL Deletions


Growth Hormone Agents

Pimecrolimus  Cream

Skin & Mucous Membrane Agents-Misc.

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 https://medicaid.alabama.gov/content/9.0_Resources/9.4_Forms_Library/9.4.13_Pharmacy_Forms.aspx.


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.

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2021 American Medical Association and © 2021 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.

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