Washington Preferred Drug List (WPDL)
Washington State Health Care Authority sent this bulletin at 05/20/2016 02:42 PM PDTDear Provider,
Effective for claims with dates of service on and after July 1 2016, Washington Apple Health (Medicaid) administered by the Health Care Authority (agency) will add Long-Acting Insulins to the Washington Preferred Drug List (WPDL) and require prior authorization on all drugs in the class.
WPDL status for Long-Acting Insulins is as follows:
Drug Class |
Drug Name |
Preferred Status |
Long-Acting Insulins (new drug class) |
Lantus® |
Preferred, PA required |
Lantus Solostar® |
Preferred, PA required |
|
Levemir® |
Non-Preferred, PA required |
|
Levemir Flexpen® |
Non-Preferred, PA required |
|
Levemir Flextouch® |
Non-Preferred, PA required |
|
Repatha Sureclick® |
Preferred, PA required |
|
Toujeo Solostar® |
Non-Preferred, PA required |
|
Tresiba® Flextouch® |
Non-Preferred, not subject to TIP/DAW-1 override, and PA required |
For more details, see the agency’s Washington Preferred Drug List (WPDL).
All drugs in the Long-Acting Insulin class will require prior authorization according to the following criteria.
Patient is not concurrently taking a product containing exanatide, liraglutide, or rosiglitazone; has no other contraindications or hypersensitivities to insulin products or one of their excipients, and:
- Diagnosis of Type 1 Diabetes Mellitus; or
- Diagnosis of Type 2 Diabete Mellitus and patient has been uncontrolled when using other basal insulin regimens, such as combinations of NPH insulin with meal-time boluses of fast-acting insulin for at least 3 months. ‘Uncontrolled’ is defined as not achieving and maintaining stability at the patient specific A1C goal; or
- Diagnosis of Gestational Diabetes Mellitus and patient’s glucose is uncontrolled using a combination of NPH insulin with meal-time boluses of fast-acting insulin for at least 1 month. Uncontrolled is defined as not having maintained an average weekly postprandial reading <120mg/dL or average weekly fasting blood glucose < 90mg/dL.For more details, see the Long-Acting Insulins on the agency’s Fee-for-Service Drug Coverage Criteria page.
- Patients currently taking a Long-Acting Insulin will be approved if the above criteria was met at the time therapy was initiated.