We will continue to fill these medications until our stock is depleted. Medications not listed o n the formulary are considered to be nonformulary and are subject to prior authorization. Colorado department of health care policy and financing. Brand name required bnr, prior authorization pa therapeutic drug class preferred agents nonpreferred agents prior authorization criteria. Nc medicaid manages the states medicaid and nc health choice health care programs, pharmacy benefits, and behavioral health services. Understanding medicaid drug formularies the honest.
District of columbia department of health care finance pharmacy preferred drug list pdl effective march 19th, 2020 nonpreferred medications require prior authorization page 3 of 21 antiinfectives drug class preferred requires prior authorization. Prior authorization list, criteria, and forms located at. The patient must have failed a 30day trial of each pharmaceutically. The plan may limit coverage to a specific quantity or a specific course of treatment. Nevada medicaid and nevada checkup preferred drug list pdl effective january 1, 2017 pdl exception pa. The medicaid pharmacy list of reimbursable drugs includes only those drugs covered under the pharmacy benefit and is not inclusive of all covered practitioner administered drugs. Some drugs have limitations on age, dosage, or maximum quantities.
This website will help prescribers and pharmacists understand pharmacy services provided through public health programs, n. Connecticut medicaid preferred drug list pdl the connecticut medicaid preferred drug list pdl is a listing of prescription products selected by the pharmaceutical and therapeutics committee as efficacious, safe and cost effective choices when prescribing for husky a, husky c, husky d, tuberculosis tb and family planning fampl clients. It does not include changes made between meeting dates. Nonpreferred drugs in these classes require prior authorization pa, unless indicated otherwise. Pfizer has removed this medication from their bulk replenishment program. Dilaudid hydromorphone morphine oxycodone oxycodoneacetaminophen oxycodoneaspirin oxymorphone percocet percodan roxicodone. Connecticut medicaid preferred drug list pdl preferred drug notations brand name calcitoninsalmon 200 units spray nasal fortical calcium acetate capsule, gelcap, tablet oral phoslo, calphron. A preferred drug list pdl is a list of medications that are covered. Preferred drug list office of medicaid business and. Monthly behavioral health training assistance bhta webinar scheduled see web announcement 2009. The 2018 molina healthcare of michigan preferred drug list formulary is the michigan medicaid managed care common formulary. Nebraska medicaid preferred drug list with prior authorization criteria pdl updated october 1, 2017 highlights indicated change from previous posting.
Nc medicaid and health choice preferred drug list pdl. If you have any questions about coverage of a certain product, please contact us at 8004543730. The program is jointly funded by north carolina and the. In each class, drugs are listed alphabetically by either brand name or generic name. Nebraska total care covers prescription medications and certain overthecounter medications with a written order from a nebraska total care provider. This list is called the michigan medicaid managed care common formulary. Jun 26, 2012 pa requests may be submitted online, via telephone, or fax to the magellan medicaid administration clinical call center. Nc medicaid division of health benefits is dedicated to providing access to physical and behavioral health care and services to improve the health and wellbeing of over 2. Nc medicaid preferred drug list quick search options northern. Pharmacy services prior authorization is required for certain drugs prescribed to n.
South carolina medicaid preferred drug list sc dhhs. North carolina division of health benefits north carolina medicaid and health choice preferred drug list pdl effective. Providers may submit requests via fax, phone or through the secure nctracks secure provider portal. North carolina medicaid pharmacy formulary outline of medicare. In the find box type the name of the medication you want to locate. Primary insurance requires a nd medicaid nonpreferred branded product b. Only those prescription and nonprescription drugs which appear on the list are reimbursable under the feeforservice medicaid pharmacy program. New hampshire department of health and human services feefor. With the pdf open, click on the edit menu, then click find 2. North carolina division of health benefits nc medicaid. There are two ways to find your prescription drugs in the formulary.
Ky medicaid proposed formulary changes effective 1012017 unless otherwise noted table 1. Pharmacy services pharmacy services north carolina. Refer to the prior approval drugs and criteria page for specific criteria. Nebraska total care is committed to providing appropriate, highquality, and costeffective drug therapy to all nebraska total care members. Nebraska prescription drug coverage nebraska total care. The texas drug code index includes programspecific formularies for the following programs. Molina healthcare of michigan preferred drug list formulary. It does not apply to members enrolled in rocky mountain health hmo or denver health medicaid choice. The texas medicaid formulary contains all formulary products, including those on the preferred drug list, available to people enrolled in medicaid. The requested brandname product must not have an authorized generic available 2. Open the attached list and use the adobe acrobat search tool to locate specific drugs by name or hic3 therapeutic class.
Not all therapeutic drug classes are included on the pdl. Desi drugs are not covered on the medicaid formulary. Medicaid health plan common formulary state of michigan. You can read more detailed information about the pharmacy program on the nebraska total care medicaid formulary pdf. Nebraska medicaid pharmacy benefits nebraska total care. Medicaid is the program that provides health coverage to eligible lowincome adults, children, pregnant women, seniors and people with disabilities. North carolina medicaid and health choice preferred drug list pdl. You can file this post in your favorites folder entitled things they didnt teach me in pharmacy school. Pharmacy formulary cencal health insurance santa barbara. North carolina medicaid pharmacy formulary outline of.
On november 1, 2019, gabapentin will be removed from the formulary until further notice. In each class, drugs are listed alphabetically by either brand name or. New hampshire department of health and human services feeforservice medicaid preferred drug list pdl nh department of health and human services 1 office of medicaid services revision effective date august 7, 2019 notes. Requirements on when to use the national provider identifier npi of an ordering, prescribing or referring. Locate contact information for state agencies, employees, hotlines, local offices, and more. March 2, 2020 general definition of terms clinical criteria cc due to the nature of some medications, prior authorization may be required for the medication to be covered at any copay tier. Governor easley announced that nc medicaid was establishing a preferred drug list. Nonopioid alternatives pdf, 276 kb nc medicaid opioid safety stop act crosswalk pdf, 319 kb faq on naxolone standing order pdf, 251 kb provider considerations for tapering of opioids pdf, 221 kb preferred drug list opioid analgesics and combination therapy daily mme pdf, 389 kb general provider pharmacy cover letter stop act pdf. North carolina medicaid and health choice preferred drug list pdl effective july 1, 2017 trial and failure of two preferred agents are required unless otherwise indicated not all therapeutic classes are included on the pdl. These drugs are the recommended first choice when prescribing for medicaid patients. Preferred drug list utah department of health medicaid. New hampshire department of health and human services. During the 2009 legislative session, the state legislature approved sb 87, which authorizes utah medicaid to require a prior authorization for nonpreferred drugs.
Nevada medicaid and nevada check up news fourth quarter 2019 provider newsletter attention behavioral health providers. Medicaid pharmaceutical state laws and policies ncsl. All drugs in the classes not included are considered preferred. North carolina division of medical assistance north carolina medicaid and health choice preferred drug list pdl effective january 1, 2015 trial and failure of two preferred agents are required unless otherwise indicated not all therapeutic classes are included on the pdl. Prior approval pa is required for certain drugs prescribed to n. Medicaid bulletin phys dent mc hosp med clin mhrc hh pharm to. If you are working in any type of retail, community or outpatient setting you are probably interacting with a medicaid formulary in some way on a. Va anthem common core formulary medicaidapproved preferred drug list. If you are working in any type of retail, community or outpatient setting you are probably interacting with a medicaid formulary. The recommended method for submitting a pa request is to key it directly into the secure nctracks provider portal. Nevada medicaid and nevada checkup preferred drug list pdl. Va anthem common core formulary medicaid approved preferred drug list. Additionally, if a medication is available as a generic formulation, this will be amerigroups preferred agent, unless otherwise noted.
Unless otherwise specified, the listing of a particular brand or generic name includes all dosage forms of that drug. Please use the ndc drug lookup to find prior authorization pa forms guiding rules of the preferred drug list pdl. North carolina prior authorization program nctracks. North carolina medicaid and health choice preferred drug list pdl effective january 1, 2015 trial and failure of two preferred agents are required unless otherwise indicated not all therapeutic classes are included on the pdl. Search the most recent version of the preferred drug list pdl by bookmarking pdl site and not saving the pdf of the pdl on. If you are a medicaid provider whose revalidation application has not been processed by your termination due date, you will be ineligible to provide services to any nevada medicaid or nevada check up recipients, including both feeforservice and managed care organization mco enrolled recipients. All drugs covered under the nevada medicaid program are available for silversummit members.
The plan may also require prior authorization on some covered drugs. Oct 01, 2017 nebraska medicaid preferred drug list with prior authorization criteria pdl updated october 1, 2017 highlights indicated change from previous posting. North carolina sickle cell syndrome program formulary. North carolina division of medical assistance north carolina. Medications not listed o n the formulary are considered to be non formulary and are subject to prior authorization. Medicaid list of covered drugs formulary 2019 ucare. Im going to talk to you about medicaid drug formularies. Magellan medicaid administration, part of the magellan rx management division of magellan health, inc. District of columbia department of health care finance pharmacy preferred drug list pdl effective march 19th, 2020 nonpreferred medications require prior authorization page 1 of 21 analgesics drug class preferred requires prior authorization longacting narcotics clinical criteria apply to this entire therapeutic class embeda. Please use the ndc drug lookup to find prior authorization pa forms 1. North carolina medicaid and health choice preferred drug list pdl effective january 5, 2018 trial and failure of two preferred drugs are required unless otherwise indicated. Nevada medicaid and nevada checkup preferred drug list. This information relates to the prescription drug formulary.
Understanding medicaid drug formularies the honest apothecary. Visit nh healthy families today to learn what medicaid pharmacy benefits in new hampshire are covered. North carolina division of medical assistance north carolina medicaid and health choice preferred drug list pdl november 1, 2016 trial and failure of two preferred agents are required unless otherwise indicated not all therapeutic classes are included on the pdl. Medicaid childrens health insurance program chip children with special health care needs cshcn services program healthy texas women htw program kidney health care khc program managed care organizations are required to adhere to the medicaid and chip. In order to streamline drug coverage policies for medicaid and healthy michigan plan members and providers, the michigan department of health and human services mdhhs has created a formulary that is common across all contracted. May 31, 2016 service to be eligible, and must meet policy coverage criteria, unless requires the state medicaid agency to cover services, products. We are pleased to provide this formulary as a useful reference and informational tool. September 1, 2019 trial and failure of two preferred drugs are required unless only one preferred option is listed or is otherwise indicated. Providers pharmacy pharmacy formulary in this section. North carolina medicaid and health choice preferred drug list. Nov 18, 2015 ttention pharmacists and pharmacy students. Nebraska total care covers prescription medications and certain overthecounter medications with a written order from a.
Universal preferred drug list mississippi division of medicaid. Medicaid childrens health insurance program chip children with special health care needs cshcn services program healthy texas women htw program kidney health care khc program managed care organizations are required to adhere to the medicaid and chip formularies. North carolina division of medical assistance north. Preferred drug list the silversummit healthplan formulary includes a.
North carolina division of health benefits north carolina. As of october 1, 2019, nitrostat has been removed from the formulary. Nc medicaid and health choice preferred drug list pdl nc. During the 2007 legislative session, the utah state legislature passed senate bill 42 allowing medicaid to adopt a preferred drug list pdl. If you need more information about policies regarding a specific drug, consult your physician or contact the customer care center.