Washington Preferred Drug List (WPDL)

Washington State Health Care Authority sent this bulletin at 05/12/2016 03:31 PM PDT

Dear Provider,

Effective for claims with dates of service on and after June 1, 2016, 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
Antiplatelets	aspirin-dipyridamole ER	Non-Preferred
Antiplatelets	Aspirin and Extended Release Dipyridamole®	Removed
Attention Deficit/ Hyperactivity Disorder	Metadate ER™	Removed – see methylphenidate ER
Calcium Channel Blockers	Adalat®	Removed
	Cartia XT®	Removed – see diltiazem ER
	Taztia XT®	Removed – see diltiazem ER
Estrogens	Cenestin®	Removed
	Estrasorb®	Removed
	Femtrace®	Removed
Estrogen-Progestin Combinations	jinteli	Removed – see norethindrone acetate -ethinyl estradiol
Estrogen-Progestin Combinations	mimvey	Removed -- see estradiol-norethindrone
Inhaled Corticosteroids – Long-Acting Beta-Agonist Combinations (No changes to preferred drug status. Separating asthma/COPD subclasses for clarity of Therapeutic Interchange.)	Advair Diskus® /HFA®	Preferred
	Breo Ellipta®	Preferred
	Dulera®	Non-Preferred, EA required
	Symbicort®	Non-Preferred
Long-Acting Beta-Agonist – Long Acting Muscarinic Agent Combinations (LABA – LAMA) (No changes to preferred drug status. Separating asthma/COPD subclasses for clarity of Therapeutic Interchange.)	Anoro Ellipta®	Preferred, EA required
	Stioloto®	Non-Preferred, Not subject to TIP or DAW-1, and EA required
	Utibron Neohaler®	Non-Preferred, Not subject to TIP or DAW-1, and EA required
Long-Acting Muscarinic Agents (LAMA) (No changes to preferred drugs. Renaming drug class)	Incruse Ellipta®	Non-Preferred, Not subject to TIP or DAW-1, and EA required
	Seebri Neohaler®	Non-Preferred, Not subject to TIP or DAW-1, and EA required
	Spiriva Handihaler®	Preferred, EA required
	Spiriva Respimat®	Preferred, EA required
	Tudorza Pressair®	Non-Preferred, EA required
Nasal Corticosteroids	mometasone furoate	Non-Preferred
PCSK-9 Inhibitors (Proprotein Convertase Subtilisin Kexin Type 9) (new drug class)	Praluent®	Non-Preferred, PA required
	Repatha®	Preferred, PA required
	Repatha Sureclick®	Preferred, PA required
Statin-type Cholesterol Lowering Agents (No changes to preferred drug status. Separating asthma/COPD subclasses for clarityof Therapeutic Interchange.)	atorvastatin	High Potency, Preferred
	Crestor®	High Potency, Non-preferred, Not subject to DAW-1 override
	Lipitor®	High Potency, Non-preferred
Targeted Immune Modulaters	Taltz®	Non-preferred, not subject to DAW-1 override
Triptans	Onzetra®	Non-Preferred, not subject to TIP/DAW-1 override

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

NOTE: Please do not reply directly to this message. If you have feedback or questions, please visit the HCA website at http://www.hca.wa.gov/medicaid/Pages/contact.aspx. That way, your message can be delivered to the appropriate staff.

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Washington Preferred Drug List (WPDL)

Drug Class

Drug Name

Preferred Status