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Tags:  health  dental health  oral surgeon  oral health 
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Published:  November 15, 2011

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Slide 1: To: Pharmacies, Physicians, Physician Assistants, Nurse Practitioners, Oral Surgeons, Optometrists, Dentists, FQHCs, RHCs, Nursing Homes, and Mental Health Providers RE: Preferred Drug List (PDL) Update Effective July 1, 2009 the Alabama Medicaid Agency will update the Preferred Drug List (PDL) to reflect the recent Pharmacy and Therapeutics (P&T) Committee’s recommendations as well as quarterly updates. The updates are listed below: PDL Additions Astelin - EENT Preparations/Antiallergic Agents Astepro - EENT Preparations/Antiallergic Agents Elidel - Skin and Mucous Membrane Agents/Miscellaneous Levemir - Diabetic Agents/Insulins PDL Deletions* Metrogel Vaginal - Skin and Mucous Membrane Agents/Antibacterials Luvox CR - Behavioral Health/Antidepressants Pramox - Skin and Mucous Membrane Agents/Antipruritics * Denotes that these brands will no longer be preferred but are still covered by Alabama Medicaid and will require Prior Authorization (PA). Available covered generic equivalents (unless otherwise specified) will remain preferred. The PA request form and criteria booklet, as well as a link for a PA request form that can be completed and submitted electronically online, can be found on the Agency’s website at and should be utilized by the prescribing physician or the dispensing pharmacy when requesting a PA. Providers are to mail or fax hard copy PA requests to: Health Information Designs (HID) Medicaid Pharmacy Administrative Services P. O. Box 3210 Auburn, AL 36832-3210 Fax: 1-800-748-0116 Phone: 1-800-748-0130 Incomplete PA requests or those failing to meet Medicaid criteria will be denied. If the prescribing physician believes medical justification should be considered, the physician must document this on the form or submit a written letter of medical justification along with the prior authorization form to HID. Additional information may be requested. Staff physicians will review this information. Policy questions concerning this provider notice should be directed to the Pharmacy Program at (334) 242-5050. Questions regarding prior authorization procedures should be directed to the HID help desk at 1-800-748-0130. June 10, 2009

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