�6")T�k3w�W.�˭vF��1�Y��~%��� '�p�.J�7Ge�i�Ho���� JUJ2IgM��P�&��0�����+�[�B� �`W�����S����CP�[���p�jr�{,�K|����@áT�v��P��R'. Effective: January 1, 2020 Alphabetical by drug name - Posted 12/02/20. Perform the search via the following steps: Search for a Drug … Fee-for-service plan only Preferred drug lists (PDL) The Apple Health (Medicaid) Fee-For-Service Preferred Drug List no longer applies. The quarterly P&T Committee meeting was held on September 18, 2020. This is a list of drugs covered by your plan. Preferred Drug List [1.08MB PDF] Updated 10/14/2020. This is a list of drugs covered by your plan. endobj 600 E Boulevard Ave Dept 325. 2020 LIST OF COVERED DRUGS (FORMULARY) Health Details: v UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program.Enrollment in the plan depends on the plan’s contract renewal with Medicare. North Carolina Division of Health Benefits North Carolina Medicaid and Health Choice Preferred Drug List (PDL) Effective: September 1, 2020 T. Preferred Non-Preferred. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC The Ohio Department of Medicaid is implementing a Unified Preferred Drug List (UPDL) on January 1st, 2020 that will encompass the entire Medicaid population regardless of enrollment in Managed Care or Fee for Service (FFS). Please see your 2020 Formulary document for details. �Ĭ�������'��ᚎ�nZ��Id$�)I����t粁4�;�������.���� Legend . NC Medicaid would like to share information about recent FDA guidance regarding REMS requirements during the COVID-19 public health emergency. AmeriHealth Caritas North Carolina covers certain over-the-counter medications and products. Pharmacy Lock-in Program. Covered (BadgerCare Plus and Medicaid) (Effective 1/1/2018) donepezil 5mg, 10mg tablet/ODT (generic for Aricept®/ ODT) Aricept®Tablet Exelon®Patch donepezil 23mg tablet (generic for Aricept®) memantine tablet/titration pack (generic for Namenda®) galantamine ER capsule / solution / tablet … Open the attached list and use the Adobe Acrobat search tool to locate specific drugs by name or HIC3 therapeutic class. 2020 Preferred Drug List Humana Medical Plan All Regions PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. Preferred Drug List - Effective 12/01/2020 Information Disclaimer Medicaid Preferred Drug List Page Content You may register to receive E-mail notification, when a new Preferred Drug List is posted to the Web site, by completing the form for Preferred Drug List E-Mail Notification Request . 2 Preferred Drug List What is the Preferred Drug List? Rx (PDP) Medicare Prescription. v The Drug List (formulary) may change on January 1 of each year, and from time to time … AL: Age Limit Restrictions . Our contact information is on the cover. NC Medicaid and Health Choice Clinical Coverage Policy for Outpatient Pharmacy Services; 2020 NC Medicaid Pharmacy Newsletters; 2019 NC Medicaid Pharmacy Newsletters; NC Medicaid Preferred Drug List; NC Medicaid Provider Bulletins Find out more. 2020 LIST OF COVERED DRUGS (FORMULARY) Health Details: v UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program.Enrollment in the plan depends on the plan’s contract renewal with Medicare. 2021 WellCare Drug List (Formulary) Search Tool. To get drugs not on the Preferred Drug List, your provider will need to get prior authorization from Health First Colorado. Drug Plan. THIS FORMULARY WAS UPDATED ON 11/05/2020. Bismarck, ND 58505-0250 . Note: THIS FORMULARY WAS UPDATED ON 11/05/2020. 2020 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. Virginia Medicaid’s Preferred Drug List (PDL)/Common Core Formulary 7/1/20 3 | P a g e *Methadone Drugs Dolophine® Methadose® oral soln & tab methadone oral soln & tab *Methadone requires the completion of the Clinical SA form (Methadone SA Form) unless prescribed for neonatal abstinence syndrome for an infant under the age of one. %PDF-1.7 Alphabetical by drug name - Posted 11/02/20. Rx (PDP) Medicare Prescription. We are pleased to provide the 2020 Molina Healthcare of Washington Apple Health (Medicaid) Preferred Drug List (Formulary) as a useful reference and informational tool. In each class, drugs are listed alphabetically by either brand name or generic name. Highlights indicated change from previous posting. This drug list has changed since last … Prescribers are encouraged to write prescriptions for “preferred” products. 600 E Boulevard Ave Dept 325. That pledge demands the highest standards of care and service. Blue Cross NC’s prior review, restricted-access, non-formulary exceptions and 2020 Preferred Drug List (PDL) - November 2020. is a guide within select therapeutic categories for plan members enrolled in the traditional pharmacy benefit and their health care providers. Providers, please visit our website at Generic drug: Lowercase in plain type . donepezil 5mg, 10mg tablet/ODT (generic for Aricept®/ ODT) Aricept®Tablet Exelon®Patch donepezil 23mg tablet (generic for Aricept®) memantine tablet/titration pack (generic for Namenda®) galantamine ER capsule / solution / tablet … Welcome to the Nebraska Medicaid program Web site. 2 Preferred Drug List What is the Preferred Drug List? Our lock-in program assigns members to a specific pharmacy and prescriber provider. <> › Verified 3 days ago Please see your 2020 Formulary document for details. January 2020 North Carolina State Health Plan Preferred Drug List - Traditional Pharmacy Benefit. • Preferred Drug List Partners in Quality Care Dear Provider Partner: members – your patients. Idaho Medicaid Preferred Drug List with Prior Authorization Criteria. 2 0 obj Find out more. <>/Font<>/XObject<>/Pattern<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> PDL Updated January 1, 2020. NON-PREFERRED –. North Carolina Division of Health Benefits North Carolina Medicaid and Health Choice Preferred Drug List (PDL) Effective: December 1, 2020 Trial and failure of two Preferred drugs are required unless only one Preferred option is listed or is otherwise indicated. Suprax susp® Trial and failure of 2 Preferred products required prior to Non-Preferred products. 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. The drug should be filled at an in-network pharmacy and … Version 2020.1 . 201 W. Preston Street, Baltimore, MD 21201-2399 (410) 767-6500 or 1-877-463-3464 Facilitator, Blake Cook, NC Medicaid Outpatient Pharmacy Interim Pharmacy Director began the meeting by welcoming attendees to the … endobj DIFFERIN 0.3% GEL PUMP (TOPICAL) (DX CODE REQ.) Preferred Drug List (PDL). Idaho Medicaid Preferred Drug List with Prior Authorization Criteria. 2020 Preferred Drug List (PDL) - December 2020. Preferred Drug List – Idaho Health and Welfare. 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. Effective December 1, 2020. The WellCare Drug List (Formulary) tool allows you to search prescription drug names to determine 2021 plan coverage for your formulary. Brand name drug: Uppercase in bold type . North Dakota Department of Human Services. The NC Medicaid Preferred Drug List (PDL) allows NC Medicaid to obtain better prices for covered outpatient drugs through supplemental rebates. AmeriHealth Caritas North Carolina covers certain over-the-counter medications and products. UNIVERSAL PREFERRED DRUG LIST (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. Locate contact information for state agencies, employees, hotlines, local offices, and more. Home | UAC | Reference | Site Map. NC Medicaid (Division of Health Benefits) is dedicated to providing access to physical and behavioral health care and services to improve the health and well-being of over 2.1 million North Carolinians on behalf of the North Carolina Department of Health and Human Services. South Carolina Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) WellCare of South Carolina 00 Please read: This document contains information about the drugs we cover in this plan. Details: Florida Medicaid Preferred Drug List (effective 10-01-2020) The Florida Medicaid Preferred Drug List (PDL) is subject to revision following consideration and recommendations by the Pharmaceutical and Therapeutics (P&T) Committee and the Agency for Health Care Administration. Please see … Drug List by the + symbol. ALISKIREN/VALSARTAN (VALTURNA)* CIPROFLOXACIN 0.3%/DEXAMETHASONE 0.1% (CIPRODEX) ELBASVIR/GRAZOPREVIR (ZEPATIER)* NEOMYCIN/POLYMIXIN/HC SOLN/SUSP (CORTISPORIN) SOFOSBUVIR/VELPATASVIR (EPCLUSA)*. Not all … Silver State Scripts Board Makes Changes to Preferred Drug List (PDL) Effective June 1, 2020 Jan. 2, 2020 Silver State Scripts Board Makes Changes to Preferred Drug List (PDL) Effective January 1, 2020 %���� Molina Healthcare of Washington Medicaid Preferred Drug List (Formulary) (11/01/2020) INTRODUCTION. Medicaid List of Covered Drugs (Formulary) 2020 ... cover the drugs listed in the list of covered drugs as long as the drug is medically necessary, the prescription is filled at a HealthPartners network pharmacy and other require ments related to the drug are followed. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC NC Medicaid and Health Choice Preferred Drug List (PDL) effective Jan. 1, 2020 NC Department of Health and Human Services 2001 Mail Service Center Raleigh, NC 27699-2001 919-855-4800 Medicaid Formulary (Drug List) 2020.A formulary is a list of covered drugs.The Medicaid formulary is a useful reference to assist practitioners in selecting clinically appropriate and cost-effective drug therapies.Medicaid Formulary Updates. Effective December 1, 2020. Please read the first page for important additional information. In addition, there are medications and/or classes of medications that are not reviewed by the committee. Effective: January 1, 2020 2020 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. x��U�o�0~�����jۉ�D�* �JQ[�i��`h$[�*�ߝ�X���Ѿ\��~|w�������Y��л��w� �B*%b�� ���}9����w�kߓ0�)#E��Ҟ���g߃s� WELCOME AND INTRODUCTIONS. Telephone. 1 0 obj DO: Dose Optimization Program . Pharmacy Lock-in Program. Generic drug: Lowercase in plain type . Blue Cross NC’s prior review, restricted-access, non-formulary exceptions and Suprax susp® Trial and failure of 2 Preferred products required prior to Non-Preferred products. The 2020 Medicaid Pharmacy Newsletters can be viewed here. North Carolina Division of Health Benefits North Carolina Medicaid and Health Choice Preferred Drug List (PDL) Effective: February 1, 2020 T. Preferred Non-Preferred. The Health First Colorado (Colorado's Medicaid Program) Preferred Drug Listincludes clinically effective medications that you can get without needing prior authorization or approval. endobj Preferred Drug List – Idaho Health and Welfare. Drug Plan. Connecticut Medicaid Preferred Drug List (PDL) This document can assist medical providers in selecting Preferred Drug List. <> December 2019 . NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES 2020 PREFERRED DRUG LIST REVIEW PANEL MEETING WEDNESDAY JULY 15, 2020 1:00PM- 5:00PM VIRTUAL ONLINE MEETING PLATFORM. New York Medicaid Medicaid-Approved Preferred Drug List. AL: Age Limit Restrictions . Drug List (PDL) / Common Core Formulary QuickList Effective January 1, 2020 General Information: • Virginia Medicaid’s Preferred Drug List (PDL) only includes select drug classes • PDL preferred drugs do not require Service Authorizations (SA) unless subject to additional clinical criteria (e.g., long acting opioids, hepatitis C therapies, 201 W. Preston Street, Baltimore, MD 21201-2399 (410) 767-6500 or 1-877-463-3464 Details: Florida Medicaid Preferred Drug List (effective 10-01-2020) The Florida Medicaid Preferred Drug List (PDL) is subject to revision following consideration and recommendations by the Pharmaceutical and Therapeutics (P&T) Committee and the Agency for Health Care Administration. 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. The 2020 Medicaid Pharmacy Newsletters can be viewed on the DHB website. Preferred Drug List (PDL) & Prior Authorization Criteria . Archived Web Announcements; Documents. View the NC Medicaid PDL to find a covered medicine. Please note that the South Carolina Medicaid Preferred Drug List is updated quarterly. You may still be able to get drugs not on the Preferred Drug List. If you have additional questions about the PDL program, you may contact Medicaid Client Services at (800) 852-3345, ext. 4344, or Magellan Medicaid Administration (MMA) at (866) 664-4506. Over-the-counter medications and products. 2020 Preferred Drug List Humana Medical Plan All Regions PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. Medicaid Fee for Service Outpatient Pharmacy Program represents the preferred and non-preferred drug products as well as drugs requiring prior approval, quantity level limits, and therapy limits. <>/Metadata 3184 0 R/ViewerPreferences 3185 0 R>> DO: Dose Optimization Program . Stay up to date with us. cefdinir cap/susp (generic for Omnicef cap/susp®) cefditoren (generic for Spectracef®) cefixime cap/susp (generic for Suprax®) cefpodoxime (generic for Vantin®) Suprax chew/tab®. The PDL was authorized by the NC General Assembly Session Law 2009-451, Sections 10.66(a)-(d). PDL_January_1_2020.pdf. 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