The guidelines are available on the department's Pharmacy Prior Authorization Clinical Guidelines website under "Statewide PDL Prior Authorization Guidelines.". Michigan Preferred Drug List (PDL)/Single PDL Effective 12/15/2020 Preferred Agents do not require prior authorization, except as noted in the chart at the bottom of the page 1 Prior Authorization Not Required for Beneficiaries Under the Age of 12. Keystone State. Pharmacy Policy Cheat Sheet. MassHealth Supplemental Rebate/Preferred Drug List Link to the list of drugs preferred by MassHealth based on supplemental rebate agreements between MassHealth and drug manufacturers. *Statewide Preferred Drug List (PDL) Effective January 1, 2020* As of January 1, 2020, all managed care organizations (MCOs) that provide outpatient drug services to Medicaid beneficiaries in Pennsylvania and the State Fee-for-Service (FFS) program will use the same Preferred Drug List (PDL). Alphabetical by drug therapeutic class - Posted 12/02/20. Most drugs are identified as “preferred” or “non-preferred”. When considering medications from a class included on the Statewide PDL for MA beneficiaries, providers should try to utilize drugs that are designated as preferred. Change Healthcare negotiates and contracts Supplemental Rebate Agreements with pharmaceutical manufacturers on behalf of the Commonwealth, provides Pharmacy and Therapeutics (P&T) Committee support and clinical and financial review of drugs in PDL classes. MassHealth Supplemental Rebate/Preferred Drug List Link to the list of drugs preferred by MassHealth based on supplemental rebate agreements between MassHealth and drug manufacturers. For all listings for the current year, view PDL … Department of Human Services > For Providers > Pharmacy Services > Pharmacy Services Prior Authorization Clinical Guidelines Begin Main Content Area The department's Pharmacy and Therapeutics (P&T) Committee, which is comprised of external physicians, pharmacists, consumer representatives, and voting members from each of the HealthChoices and Community Health Choices MCOs, recommends therapeutic classes to include on the PDL, preferred or non-preferred status for the drugs in each class, and corresponding prior authorization guidelines for each class. Pharmacy Billing Manual. Medicaid agencies must make payment for all Medicaid covered drugs when they are medically necessary. 2 Quantity limits apply – Refer to document at Non-Preferred stimulants require PA. Clinical criteria for approval of a PA request for a non-preferred stimulant are bothof the following: 1. Montana Medicaid Preferred Drug List (PDL) Revised July 8, 2020 *Indicates a generic is available without prior authorization This list may not include all available generic formulations listed specifically by name Note: Brand Named Drugs are capitalized, generic drugs start with lower case letters. The committee's recommendations are approved by the secretary of the Department of Human Services (DHS) prior to implementation. Prior authorization requests for beneficiaries who receive their pharmacy benefits through the Fee-for-Service delivery system should be directed to the DHS Pharmacy Services division. Drugs designated as non-preferred on the Statewide PDL remain available to MA beneficiaries when determined to be medically necessary through the prior authorization process. MeridianRx Member Web Prior Authorization Some medications will still be covered because of the disease they treat (this is called "grandfathering”). ... providers may call 1-888-445-0497; members should call 1-866-796-2463. When drugs within a class are clinically equivalent, the committee considers the comparative cost-effectiveness of the drugs in the class. The Change Healthcare website provides information on the following items: Pennsylvania Medical Assistance Preferred Drug List, Pharmacy and Therapeutics (P&T) Committee. All preferred drugs that require clinical prior authorization remain available to MA beneficiaries when found to be medically necessary. Illinois Formulary Quarterly Summary-Last updated 7/25/2019. F-00401 (01/2020) FORWARDHEALTH PRIOR AUTHORIZATION / PREFERRED DRUG LIST (PA/PDL) FOR EXPEDITED EMERGENCY SUPPLY REQUEST . Florida Medicaid Preferred Drug List, opens new window. The committee's recommendations are based on the clinical effectiveness, safety, outcomes, and unique indications of all drugs included in each PDL class. PA/PDL for Eucrisa Instructions Page 3 of 4 F-02572A (01/2020) Element 18 Check the appropriate box to indicate whether or not the member has used Elidel or Protopic and experienced a clinically significant adverse drug reaction. Pharmacy Provider Manuals Pharmacy Policy Manual. A non-preferred Antipsychotic. *Statewide Preferred Drug List (PDL) Effective January 1, 2020* As of January 1, 2020, all managed care organizations (MCOs) that provide outpatient drug services to Medicaid beneficiaries in Pennsylvania and the State Fee-for-Service (FFS) program will use the same Preferred Drug List (PDL). Proudly founded in 1681 as a place of tolerance and freedom. ForwardHealth makes recommendations to the Wisconsin Medicaid Pharmacy PA Advisory Committee on whether certain PDL drugs should be preferred or non-preferred. 1.2. 2020 Formulary-Last updated 12/16/2020. For Clinic Administered Drugs- Prior authorization criteria for medication claims processed by physician/clinic billing using 837P codes can be found at the end of this document or by using this link: Clinic Administered Drugs - Prior Authorization Criteria. The prior authorization guidelines for drugs and drug classes included on the Statewide PDL apply to beneficiaries who receive their pharmacy benefits through the FFS delivery system and to beneficiaries who receive their pharmacy benefits through one of the HealthChoices/Community HealthChoices MCOs. Saturday 12/26/2020 09:51 PM EST . PDL Update June 1, 2020 Highlightsindicated change from previous posting Unless otherwise specified, the listing of a particular brand or generic name includes all dosage forms of … 2020 Preferred Drug List (PDL) - December 2020. VII Paper PA process only Refer to topic #15937 Uses specific Drug PA Form - available The Department contracts with Change Healthcare to provide consultation and support for the Statewide PDL. At least one of the following is true: 1.1. The PDL Packet - Summer 2020 Newsletter . Requirements for Prior Authorization of Antipsychotics A. Statewide Preferred Drug List (PDL) Opens In A New Window The Department of Human Services ("the department") maintains a Statewide Preferred Drug List (PDL) to ensure that Medical Assistance (MA) program beneficiaries in the Fee-for-Service (FFS) and HealthChoices/Community HealthChoices Managed Care Organization delivery systems have access to clinically effective pharmaceutical care … Alphabetical by drug name - Posted 12/02/20. Develop a skilled workforce that meets the needs of Pennsylvania's business community, Provide universal access to high-quality early childhood education, Provide high-quality supports and protections to vulnerable Pennsylvanians. Current PDL: effective October 1, 2020; Future PDL: effective January 1, 2021; PDL Change Provider Notices. PRIOR AUTHORIZATION / PREFERRED DRUG LIST (PA/PDL) FOR BELSOMRA AND DAYVIGO . The Pennsylvania Medical Assistance Program Fee-For-Service Preferred Drug List (PDL) is supported by Change Healthcare. Before completing this form, read the Prior Authorization/Preferred Drug List (PA/PDL) Expedited Emergency Supply Request Instructions, F-00401A. Preferred Drug List (PDL) Prior Authorization Forms. Statewide Preferred Drug List (PDL) Effective January 1, 2020 AR = age restriction, clinical prior authorization required PA = clinical prior authorization required Non-preferred medications require prior authorization QL = quantity limit applies to FFS claims IR = immediate-release formulation ER = extended-release formulation INSTRUCTIONS: Type or print clearly. Apple Health PDL 10/23/2020 - 10/29/2020; Apple Health PDL 10/16/2020 - 10/22/2020; Apple Health PDL 10/9/2020 - 10/15/2020; Apple Health PDL 10/1/2020 - 10/8/2020; View all Apple Health PDLs. Days’ Supply Requested (Up to 365 Days) All non-preferred drugs on the Statewide PDL remain available to MA beneficiaries when found to be medically necessary. For medications not on this list, FDA or compendia supported indications are required. Additional information regarding quantity limits for beneficiaries who receive their pharmacy benefits from one of the HealthChoices or Community HealthChoices MCOs is available directly from each MCO. 2020 AHCA Non-Formulary Alternatives List, PDF opens new window. Drugs that fall into a class on the Statewide PDL are generally designated as non-preferred until they are reviewed by the P&T committee. accepts prior authorization requests by phone at 1-877-PA-TEXAS (1-877-728-3927) or online. Florida’s Agency for Health Care Administration (AHCA) regularly updates the Florida Medicaid Preferred Drug List. 2 Quantity limits apply – Refer to document at PRIOR AUTHORIZATION / PREFERRED DRUG LIST (PA/PDL) EXEMPTION REQUEST Page 3 of 3 F-11075 (09/2013) SECTION V — FOR PHARMACY PROVIDERS USING STAT-PA. 23. Current PDL: effective October 1, 2020; Future PDL: effective January 1, 2021; PDL Change Provider Notices. Less than 2% of Medicaid covered drugs that are not included on the Statewide PDL require clinical prior authorization in the FFS delivery system. Illinois Some drugs that are not included on the Statewide PDL may require clinical prior authorization by the beneficiary's MCO or FFS. universal preferred drug list version 2020. Effective April 1, 2020 The Preferred Drug List (PDL) has products listed in groups by drug class, drug name, dosage form, and PDL status Multi-source drugs are listed by both brand and generic names when applicable ADHD Agents: Prior authorization required for participants under 6 years of age and participants 19 years of age and older Some medications will still be covered because of the disease they treat (this is called "grandfathering”). F-01673 (09/2020) FORWARDHEALTH . Please see the link below for changes to the formulary for patients with Florida Medicaid coverage. 2. PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES I. 2020 Preferred Drug List (PDL) - December 2020. A formulary is a list of all drugs that are covered by a payer. TennCare Preferred Drug List (PDL) Effective December 1, 2020 PA – Prior Authorization required, subject to specific PA criteria; QL – Quantity Limit (PA & NP agents require a PA before dispensing); 2020 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN Formulary File 20224, Version 19 This formulary was updated on December 1, 2020. Change Healthcare negotiates and contracts Supplemental Rebate Agreements with pharmaceutical manufacturers on behalf of the Commonwealth, provides Pharmacy and Therapeutics (P&T) Committee support and clinical and financial review of drugs in PDL classes. All drugs designated as preferred with clinical prior authorization on the Statewide PDL require prior authorization through the beneficiary's pharmacy benefits provider. Louisiana Medicaid Preferred Drug List (PDL)/Non-Preferred Drug List (NPDL) • The PDL is a list of over 100 therapeutic classes reviewed by the Pharmaceutical & Therapeutics (P&T) committee. Prescriptions That Require Prior Authorization Prescriptions for Antipsychotics that meet any of the following conditions must be prior authorized: 1. The Department of Human Services ("the department") maintains a Statewide Preferred Drug List (PDL) to ensure that Medical Assistance (MA) program beneficiaries in the Fee-for-Service (FFS) and HealthChoices/Community HealthChoices Managed Care Organization delivery systems have access to clinically effective pharmaceutical care with an emphasis on quality, safety, and optimal results from the drugs that are prescribed for them. VII Paper PA process only Refer to topic #15937 Uses specific Drug PA Form - available Alphabetical by drug name - Posted 12/02/20. Providers may refer to the Forms page of the ForwardHealth Portal at These changes may or may not affect you. Medication Prior Authorization Request Form. PDL changes provider notice: effective October 1, 2020; PDL changes provider notice: effective January 1, 2021; PDL Overview. Page 3 of 95 National Drug Code (11 Digits) 24. The member took Vyvanse and experienced a clinically significant adverse drug reaction. Drugs identified on the PDL as Recent PDL Publications. PDL Effective July 10 2020 Physicians' Summarized PDL General Criteria for all PDL categories - For more information or help using the PDL, providers may call 1-888-445-0497; members should call 1-866-796-2463. Alphabetical by drug therapeutic class - Posted 12/02/20. The member took a methyl… Machine Readable Format Formulary Definition File. In Medicaid, the list of covered drugs is determined by CMS and is based on whether the manufacturer agrees to pay the federally mandated Medicaid drug rebate. All Medicaid covered drugs are available to beneficiaries when medically necessary regardless of the drugs' inclusion on the Statewide PDL. PRIOR AUTHORIZATION / PREFERRED DRUG LIST (PA/PDL) FOR BELSOMRA AND DAYVIGO . Anuj Kalia, David Andersen, Michael Kaminsky SoCC ’20, October 19–21, 2020, Virtual Event, USA. All drugs designated as non-preferred on the Statewide PDL require prior authorization through the beneficiary's pharmacy benefits provider. In addition, there are medications and/or classes of medications that are not reviewed by the committee. For Clinic Administered Drugs- Prior authorization criteria for medication claims processed by physician/clinic billing using 837P codes can be found at the end of this document or by using this link: Clinic Administered Drugs - Prior Authorization Criteria. Medicaid Preferred Drug List (PDL) On January 1, 2020, County Care will cover medications that are selected by Illinois Medicaid. Additional information regarding prior authorization of drugs not included on the Statewide PDL for beneficiaries who receive their pharmacy benefits from one of the HealthChoices or Community HealthChoices MCOs is available directly from each MCO. Wisconsin Medicaid, BadgerCare Plus Standard, and SeniorCare Preferred Drug List - Quick Reference Revised 3/30/2020 (Effective 04/01/2020) Page 4 of 13 Brand Before Generic Drug Refer to topic #20077 Monthly Changes to the PDL Uses PA/DGA Form/Sec. Prescribing Policy Cheat Sheet. The PDL is a medication list recommended to DOM by the P&T Committee and approved by the executive director of DOM. Some preferred drugs on the Statewide PDL require a clinical prior authorization. INSTRUCTIONS: Type or print clearly. Medicaid Preferred Drug List (PDL) On January 1, 2020, County Care will cover medications that are selected by Illinois Medicaid. The next anticipated update will be July 1, 2020. Medicaid-covered drugs in therapeutic classes that are not included in the Statewide PDL remain covered drugs for beneficiaries. At least one of the following is true: 2.1. Prior authorization requests for beneficiaries who receive their pharmacy benefits through a HealthChoices or Community HealthChoices MCO should be directed to the applicable MCO. Medicaid programs and Medicaid MCOs may manage the list of covered drugs through a Preferred Drug List (PDL) and/or prior authorization. Pharmacy Prior Authorization Center Phone #: 1-866-409-8386 (toll-free) Fax #: 1-866-759-4110 (toll-free) ** New Therapeutic Class added to PDL effective 7/1/20 * New Drug added to the PDL effective 7/1/20 CONNECTICUT MEDICAID Preferred Drug List (PDL) • The Connecticut Medicaid Preferred Drug List (PDL) is a The department maintains a list of drugs that are subject to quantity limits or daily dose limits for beneficiaries in the FFS delivery system. Pennsylvania Department of Human Services Statewide Preferred Drug List (PDL)* Effective January 1, 2020 The Statewide PDL is not an all-inclusive list of drugs covered by Medical Assistance. The Statewide PDL is not the same as the formularies that are commonly used by commercial insurers. Recent PDL Publications. Below are links to charts that show some commonly used medications impacted by Humana commercial and Medicare formulary changes in 2020 (e.g., prior authorization [PA] requirements, step therapy [ST] modifications and nonformulary [NF] changes). PDL changes provider notice: effective October 1, 2020; PDL changes provider notice: effective January 1, 2021; PDL Overview. The Statewide PDL applies to beneficiaries who receive their pharmacy benefits through the FFS delivery system and to beneficiaries who receive their pharmacy benefits through one of the HealthChoices/Community HealthChoices MCOs. For medications not on this list, FDA or compendia supported indications are required. Payers cover drugs that are listed on their formularies, and drugs that are not included on their formularies are generally not covered. INSTRUCTIONS: Type or print clearly. 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