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. 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 … The PDL is a medication list recommended to DOM by the P&T Committee and approved by the executive director of DOM. The Department contracts with Change Healthcare to provide consultation and support for the Statewide PDL. Some preferred drugs on the Statewide PDL require a clinical prior authorization. Current PDL: effective October 1, 2020; Future PDL: effective January 1, 2021; PDL Change Provider Notices. All drugs designated as preferred with clinical prior authorization on the Statewide PDL require prior authorization through the beneficiary's pharmacy benefits provider. Non-Preferred stimulants require PA. Clinical criteria for approval of a PA request for a non-preferred stimulant are bothof the following: 1. 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). 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. 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. Drugs in Statewide PDL classes that are new to market will be non-preferred until reviewed by the DHS Pharmacy and Therapeutics Committee. Some medications will still be covered because of the disease they treat (this is called "grandfathering”). Medicaid-covered drugs in therapeutic classes that are not included in the Statewide PDL remain covered drugs for beneficiaries. ForwardHealth makes recommendations to the Wisconsin Medicaid Pharmacy PA Advisory Committee on whether certain PDL drugs should be preferred or non-preferred. The department maintains a list of drugs that are subject to quantity limits or daily dose limits for beneficiaries in the FFS delivery system. Pharmacy Provider Manuals Pharmacy Policy Manual. 2 Quantity limits apply – Refer to document at In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing a non-preferred drug within a therapeutic class. Current PDL: effective October 1, 2020; Future PDL: effective January 1, 2021; PDL Change Provider Notices. PDL changes provider notice: effective October 1, 2020; PDL changes provider notice: effective January 1, 2021; PDL Overview. 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. 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 … Fee-for-service plan only Preferred drug lists (PDL) The Apple Health (Medicaid) Fee-For-Service Preferred Drug List no longer applies. Machine Readable Format Formulary Definition File. 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. All non-preferred drugs on the Statewide PDL remain available to MA beneficiaries when found to be medically necessary. 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. Medicaid Preferred Drug List (PDL) On January 1, 2020, County Care will cover medications that are selected by Illinois Medicaid. Before completing this form, read the Prior Authorization/Preferred Drug List (PA/PDL) for Belsomra and Dayvigo Instructions, F-01673A. For … For medications not on this list, FDA or compendia supported indications are required. 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); F-01673 (09/2020) FORWARDHEALTH . F-01673 (09/2020) FORWARDHEALTH . The next anticipated update will be July 1, 2020. VII Paper PA process only Refer to topic #15937 Uses specific Drug PA Form - available It is not an exclusive list of drugs covered by Medicaid and includes approximately 35% of all Medicaid covered drugs. 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. All preferred drugs that require clinical prior authorization remain available to MA beneficiaries when found to be medically necessary. Machine Readable Format of IL Formulary. INSTRUCTIONS: Type or print clearly. Alphabetical by drug name - Posted 12/02/20. Some medications will still be covered because of the disease they treat (this is called "grandfathering”). Some drugs that are not included on the Statewide PDL may require clinical prior authorization by the beneficiary's MCO or FFS. 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. 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. Payers cover drugs that are listed on their formularies, and drugs that are not included on their formularies are generally not covered. These changes may or may not affect you. Member Request for Reimbursement Form. National Drug Code (11 Digits) 24. Prior authorization requests for beneficiaries who receive their pharmacy benefits through a HealthChoices or Community HealthChoices MCO should be directed to the applicable MCO. 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 INSTRUCTIONS: Type or print clearly. Anuj Kalia, David Andersen, Michael Kaminsky SoCC ’20, October 19–21, 2020, Virtual Event, USA. Medicaid Preferred Drug List (PDL) On January 1, 2020, County Care will cover medications that are selected by Illinois Medicaid. Pharmacy Policy Cheat Sheet. The committee's recommendations are approved by the secretary of the Department of Human Services (DHS) prior to implementation. At least one of the following is true: 1.1. Drugs identified on the PDL as A Brief Overview of the Preferred Drug List. 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. In addition, there are medications and/or classes of medications that are not reviewed by the committee. The Statewide PDL includes only a subset of all Medicaid covered drugs. Alphabetical by drug therapeutic class - 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. Proudly founded in 1681 as a place of tolerance and freedom. For more recent information or other questions, please contact SilverScript at 1-866-235-5660 or, 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 therapeutic class - Posted 12/02/20. The PDL Packet - Summer 2020 Newsletter . PRIOR AUTHORIZATION / PREFERRED DRUG LIST (PA/PDL) FOR BELSOMRA AND DAYVIGO . 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. Pharmacy Billing Manual. The Preferred Drug List (PDL) is a medication list recommended to the Bureau for Medical Services by the Medicaid Pharmaceutical and Therapeutics (P & T) Committee and approved by the Secretary of the Department of Health and Human Resources, as authorized by West Virginia Code §9-5-15. Florida’s Agency for Health Care Administration (AHCA) regularly updates the Florida Medicaid Preferred Drug List. Your 2020 Formulary SignatureValue 3-Tier This formulary is accurate as of Jan. 1, 2020 and is subject to change after this date. P & T Committee. 2020 Formulary-Last updated 12/16/2020. Publication date: January 30, 2020 For drugs in therapeutic classes and/or subclasses that do not have a preferred drug option, the “PDL PA Criteria” in the third column is not relevant but providers must obtain PDL prior authorization. PDL changes provider notice: effective October 1, 2020; PDL changes provider notice: effective January 1, 2021; PDL Overview. The Statewide PDL is not the same as the formularies that are commonly used by commercial insurers. 2 Quantity limits apply – Refer to document at Prescribing Policy Cheat Sheet. Preferred Drug List (PDL) Prior Authorization Forms. accepts prior authorization requests by phone at 1-877-PA-TEXAS (1-877-728-3927) or online. Challenges and Solutions for Fast Remote Persistent Memory Access BEST PAPER AWARD AT SoCC'20! The member took a methyl… The PDL Packet - Summer 2020 Newsletter . Anuj Kalia, David Andersen, Michael Kaminsky SoCC ’20, October 19–21, 2020, Virtual Event, USA. You may be trying to access this site from a secured browser on the server. 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. Pennsylvania Medical Assistance Statewide Preferred Drug List (PDL) Pennsylvania PDL 01-01-2020 (current) Pennsylvania PDL 01-05-2021 (2021 Statewide PDL effective January 5, 2021) *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). (For All Medicaid, MSCAN and CHIP Beneficiaries) Conduent’s SmartPA Pharmacy Application (SmartPA) is a proprietary electronic prior authorization system used for Medicaid fee for service claims. The Statewide PDL is therapeutically based. 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. Providers may refer to the Forms page of the ForwardHealth Portal at 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. At least one of the following is true: 2.1. See the Preferred Drug List (PDL) for the list of preferred 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. Recent PDL Publications. 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 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. 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. Challenges and Solutions for Fast Remote Persistent Memory Access BEST PAPER AWARD AT SoCC'20! Please enable scripts and reload this page. 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. 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. Saturday 12/26/2020 09:51 PM EST . 2020 AHCA Non-Formulary Alternatives List, PDF opens new window. 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. For all listings for the current year, view PDL … Illinois Illinois Formulary Quarterly Summary-Last updated 7/25/2019. The Statewide PDL will be updated annually, but that will not preclude beneficiaries from getting new drugs that come to market as long as they meet CMS criteria for a Medicaid covered drug. 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. 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. The member took Vyvanse for at least 60 consecutive days with a minimum of one dosage adjustment and experienced an unsatisfactory therapeutic response. Search Drug Coverage. 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 PDL is a medication list recommended to DOM by the P&T Committee and approved by the executive director of DOM. ... providers may call 1-888-445-0497; members should call 1-866-796-2463. MeridianRx Member Web Prior Authorization 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. 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. 2. The Pennsylvania Medical Assistance Program Fee-For-Service Preferred Drug List (PDL) is supported by Change Healthcare. 2020 Preferred Drug List (PDL) - December 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. 2020 Preferred Drug List (PDL) - December 2020. The committee's recommendations are based on the clinical effectiveness, safety, outcomes, and unique indications of all drugs included in each PDL class. These drugs remain available to Medicaid beneficiaries through the prior authorization process. In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing a non-preferred drug within a therapeutic class. 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. Online submission is only available for non-preferred prior authorization Medicaid agencies must make payment for all Medicaid covered drugs when they are medically necessary. A formulary is a list of all drugs that are covered by a payer. Medicaid programs and Medicaid MCOs may manage the list of covered drugs through a Preferred Drug List (PDL) and/or prior authorization. These changes may or may not affect you. All drugs designated as non-preferred on the Statewide PDL require prior authorization through the beneficiary's pharmacy benefits provider. Requirements for Prior Authorization of Antipsychotics A. F-00401 (01/2020) FORWARDHEALTH PRIOR AUTHORIZATION / PREFERRED DRUG LIST (PA/PDL) FOR EXPEDITED EMERGENCY SUPPLY REQUEST . The Pennsylvania Medical Assistance Program Fee-For-Service Preferred Drug List (PDL) is supported by Change Healthcare. When drugs within a class are clinically equivalent, the committee considers the comparative cost-effectiveness of the drugs in the class. 1.2. Most drugs are identified as “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. 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. The Preferred Drug List (PDL) is a medication list recommended to the Bureau for Medical Services by the Medicaid Pharmaceutical and Therapeutics (P & T) Committee and approved by the Secretary of the Department of Health and Human Resources, as authorized by West Virginia Code §9-5-15. The Change Healthcare website provides information on the following items: Pennsylvania Medical Assistance Preferred Drug List, Pharmacy and Therapeutics (P&T) Committee. 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 PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES I. 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. Before completing this form, read the Prior Authorization/Preferred Drug List (PA/PDL) Expedited Emergency Supply Request Instructions, F-00401A. Keystone State. Alphabetical by drug name - Posted 12/02/20. All Medicaid covered drugs are available to beneficiaries when medically necessary regardless of the drugs' inclusion on the Statewide PDL. VII Paper PA process only Refer to topic #15937 Uses specific Drug PA Form - available INSTRUCTIONS: Type or print clearly. Page 3 of 95 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. The guidelines are available on the department's Pharmacy Prior Authorization Clinical Guidelines website under "Statewide PDL Prior Authorization Guidelines.". Less than 2% of Medicaid covered drugs that are not included on the Statewide PDL require clinical prior authorization in the FFS delivery system. Please see the link below for changes to the formulary for patients with Florida Medicaid coverage. 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. 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). For medications not on this list, FDA or compendia supported indications are required. universal preferred drug list version 2020. PRIOR AUTHORIZATION / PREFERRED DRUG LIST (PA/PDL) FOR BELSOMRA AND DAYVIGO . This formulary applies to members of our UnitedHealthcare West HMO medical plans with a … Before completing this form, read the Prior Authorization/Preferred Drug List (PA/PDL) for Belsomra and Dayvigo Instructions, F-01673A. Medication Prior Authorization Request Form. Florida Medicaid Preferred Drug List, opens new window. The member took Vyvanse and experienced a clinically significant adverse drug reaction. Recent PDL Publications. 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. 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". 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