Washington Preferred Drug List (WPDL) update

HCA Apple Health Medicaid

 

Dear Provider,

Effective for claims with dates of service on and after December 1, 2015, Washington Apple Health (Medicaid) administered by the Health Care Authority (agency) will make the following changes to the Washington Preferred Drug List (WPDL).

Drug Class

Drug Name

Preferred Status

Multiple Sclerosis

Glatopa®

Preferred

mitoxantrone

Non-preferred

Rebif®

Non-preferred

Rebif Titration Pack®

Non-preferred

Rebif Rebidose®

Non-preferred

Rebif Rebidose Titration Pack®

Non-preferred

Tecfidera®

Preferred

Tecfidera Starter Pack®

Preferred

Tysabri®

Non-preferred

 

Drug Class

Drug Name

Change

Targeted Immune Modulators (TIMs)

Xeljanz®

Now subject to DAW-1 override

 

For more details, see the agency’s Washington Preferred Drug List (WPDL).

Thank you.