September 4, 2014

State of Alabama
Press Release: Medicaid

Preferred Drug List Quarterly Updates

To: All Medicaid Providers

Re: PDL Quarterly Updates

Effective October 1, 2014, the Alabama Medicaid Agency will update the Preferred Drug List (PDL) to reflect the quarterly updates. The updates are listed below: 

PDL Additions

Bethkis

Anti-infective Agents/Aminoglycosides

Cipro HC

EENT Preparations/Antibacterials

Symbicort

Respiratory/Orally Inhaled Corticosteroids

PDL Deletions

Bleph-10

EENT Preparations/Antibacterials

Ciprodex

EENT Preparations/Antibacterials

Patanase

EENT Preparations/Antiallergic Agents

Vigamox

EENT Preparations/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 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
PO 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 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