June 17, 2014

State of Alabama
Press Release: Medicaid

Preferred Drug List Update

 

TO:          Pharmacies, Physicians, Physician Assistants, Nurse Practitioners, Oral Surgeons, Optometrists, Dentists, FQHCs, RHCs, Mental Health Service Providers and Nursing Homes

 

 

Effective July 1, 2014, the Alabama Medicaid Agency will:

    

1.            Require prior authorization for payment of the below listed generics. The equivalent brand will be preferred with no PA.

·                  Use Dispense as Written (DAW) Code of 9 for these brand name products. DAW Code of 9 indicates the following: Substitution Allowed by Prescriber but Plan Requests Brand - Patient's Plan Requested Brand Product to be Dispensed.

 

Generic

Brand Name

Lidocaine Topical Patch

Lidoderm

Dexmethylphenidate HCL

Focalin

Trospium Chloride

Sanctura

Diazapam Rectal Kit

Diastat

Diastat Acudial

Modafinil

Provigil

Levalbuterol Inhalation Solution

Xopenex Inhalation Solution

 

2.            Update the Preferred Drug List (PDL) to reflect the quarterly updates. The updates are listed below:


 

PDL Additions

Azelastine HCL

(generic Astelin)

EENT Preparations/Antiallergic Agents

Diastat

Behavioral Health/Benzodiazepines

Diastat Acudial

Behavioral Health/Benzodiazepines

Elidel

Skin and Mucous Membrane/Miscellaneous

Focalin

Behavioral Health/Cerebral Stimulants-Agents used for ADHD

Lidoderm

Skin and Mucous Membrane/Antipruritics and Local Anesthetics

   

Mentax

Skin and Mucous Membrane/Antifungals

Provigil

Behavioral Health/Wakefulness Promoting Agents

Sanctura

Genitourinary Agents/Genitourinary Smooth Muscle Relaxants

Sklice

Skin and Mucous Membrane/Scabicides and Pediculicides

Strattera

Behavioral Health/Cerebral Stimulants-Agents used for ADHD

Ulesfia

Skin and Mucous Membrane/Scabicides and Pediculicides

 

Xopenex Inhalation Solution

Respiratory/Selective Beta-2 Adrenergic Agonists

Zovirax (cream only)

Skin and Mucous Membrane/Antivirals

PDL Deletions

Advair

Respiratory/Orally Inhaled Corticosteroids

Advair HFA

Respiratory/Orally Inhaled Corticosteroids

Astelin

EENT Preparations/Antiallergic Agents

Dexmethylphenidate HCL

(generic Focalin)

Behavioral Health/Cerebral Stimulants-Agents used for ADHD

Diazapam Rectal Kit

(generic Diastat)

(generic Diastat Acudial)

Behavioral Health/Benzodiazepines

Levalbuterol Inhalation Solution

(generic Xopenex)

Respiratory/Selective Beta-2 Adrenergic Agonists

Lidocaine Topical Patch

(generic Lidoderm)

Skin and Mucous Membrane/

Antipruritics and Local Anesthetics

Modafinil

Behavioral Health/ Wakefulness Promoting Agents

Trospium Chloride

(generic Sanctura)

Genitourinary Agents/

Genitourinary Smooth Muscle Relaxants

Zovirax (ointment only)

Skin and Mucous Membrane/Antivirals


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 prescribing physician 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 prescribing physician believes medical justification should be considered, the physician must document this on the form or submit a written letter of medical justification along with the prior authorization 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 prior authorization 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