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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. Prior authorization requests for beneficiaries who receive their pharmacy benefits through a HealthChoices or Community HealthChoices MCO should be directed to the applicable MCO. Requirements for Prior Authorization of Antipsychotics A. Alphabetical by drug therapeutic class - Posted 12/02/20. 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. The PDL is a medication list recommended to DOM by the P&T Committee and approved by the executive director of DOM. Some Medicaid covered drugs (both those that are included on the Statewide PDL and those that are not included on the Statewide PDL) also require prior authorization if the prescribed quantity and/or dose exceeds the dose that is approved by the FDA for each medication. The committee's recommendations are approved by the secretary of the Department of Human Services (DHS) prior to implementation. Challenges and Solutions for Fast Remote Persistent Memory Access BEST PAPER AWARD AT SoCC'20! The member took Vyvanse and experienced a clinically significant adverse drug reaction. Proudly founded in 1681 as a place of tolerance and freedom. The Pennsylvania Medical Assistance Program Fee-For-Service Preferred Drug List (PDL) is supported by Change Healthcare. A non-preferred Antipsychotic. 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. Alphabetical by drug name - Posted 12/02/20. 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. The PDL Packet - Summer 2020 Newsletter . Some drugs that are not included on the Statewide PDL may require clinical prior authorization by the beneficiary's MCO or FFS. A formulary is a list of all drugs that are covered by a payer. All non-preferred drugs on the Statewide PDL remain available to MA beneficiaries when found to be medically necessary. Alphabetical by drug name - Posted 12/02/20. It is not an exclusive list of drugs covered by Medicaid and includes approximately 35% of all Medicaid covered drugs. Medicaid programs and Medicaid MCOs may manage the list of covered drugs through a Preferred Drug List (PDL) and/or prior authorization. Prescriptions That Require Prior Authorization Prescriptions for Antipsychotics that meet any of the following conditions must be prior authorized: 1. Online submission is only available for non-preferred prior authorization 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. This formulary applies to members of our UnitedHealthcare West HMO medical plans with a … VII Paper PA process only Refer to topic #15937 Uses specific Drug PA Form - available F-01673 (09/2020) FORWARDHEALTH . In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing a non-preferred drug within a therapeutic class. 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. Before completing this form, read the Prior Authorization/Preferred Drug List (PA/PDL) for Belsomra and Dayvigo Instructions, F-01673A. PDL changes provider notice: effective October 1, 2020; PDL changes provider notice: effective January 1, 2021; PDL Overview. National Drug Code (11 Digits) 24. Some preferred drugs on the Statewide PDL require a clinical prior authorization. When drugs within a class are clinically equivalent, the committee considers the comparative cost-effectiveness of the drugs in the class. 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. These changes may or may not affect you. INSTRUCTIONS: Type or print clearly. The department maintains a list of drugs that are subject to quantity limits or daily dose limits for beneficiaries in the FFS delivery system. Department of Human Services > For Providers > Pharmacy Services > Pharmacy Services Prior Authorization Clinical Guidelines Begin Main Content Area INSTRUCTIONS: Type or print clearly. Preferred Drug List The preferred drug list is arranged by drug therapeutic class and contains a subset of many, but not all, drugs on the Medicaid formulary. At least one of the following is true: 1.1. 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. Medicaid agencies must make payment for all Medicaid covered drugs when they are medically necessary. Drugs in Statewide PDL classes that are new to market will be non-preferred until reviewed by the DHS Pharmacy and Therapeutics Committee. Medicaid Preferred Drug List (PDL) On January 1, 2020, County Care will cover medications that are selected by Illinois Medicaid. For … For medications not on this list, FDA or compendia supported indications are required. Saturday 12/26/2020 09:51 PM EST . The Statewide PDL includes only a subset of all Medicaid covered drugs. Prescribing Policy Cheat Sheet. accepts prior authorization requests by phone at 1-877-PA-TEXAS (1-877-728-3927) or online. 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. See the Preferred Drug List (PDL) for the list of preferred 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. Challenges and Solutions for Fast Remote Persistent Memory Access BEST PAPER AWARD AT SoCC'20! 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. Before completing this form, read the Prior Authorization/Preferred Drug List (PA/PDL) for Belsomra and Dayvigo Instructions, F-01673A. 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. 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 … 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. Please see the link below for changes to the formulary for patients with Florida Medicaid coverage. 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. At least one of the following is true: 2.1. 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. 2 Quantity limits apply – Refer to document at ForwardHealth makes recommendations to the Wisconsin Medicaid Pharmacy PA Advisory Committee on whether certain PDL drugs should be preferred or non-preferred. 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. Anuj Kalia, David Andersen, Michael Kaminsky SoCC ’20, October 19–21, 2020, Virtual Event, USA. Page 3 of 95 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. 2020 Formulary-Last updated 12/16/2020. The next anticipated update will be July 1, 2020. The Statewide PDL is therapeutically based. F-01673 (09/2020) FORWARDHEALTH . PDL changes provider notice: effective October 1, 2020; PDL changes provider notice: effective January 1, 2021; PDL Overview. A Brief Overview of the Preferred Drug List. 2 Quantity limits apply – Refer to document at 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. 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. 2. The list of these drugs may be found on the department's Pharmacy Prior Authorization Clinical Guidelines website under "Fee-for-Service Non-PDL Prior Authorization Guidelines". The department's P&T Committee considers new medical literature and national treatment guidelines when recommending preferred or non-preferred status for drugs on the Statewide PDL. ... providers may call 1-888-445-0497; members should call 1-866-796-2463. INSTRUCTIONS: Type or print clearly. Keystone State. Providers may refer to the Forms page of the ForwardHealth Portal at Days’ Supply Requested (Up to 365 Days) MeridianRx Member Web Prior Authorization The Statewide PDL is a list of medications that are grouped into therapeutic classes based on how the drugs work or the disease states they are intended to treat. 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); 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. 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