Washington Preferred Drug List (WPDL)

Washington State Health Care Authority sent this bulletin at 05/20/2016 02:42 PM PDT

Dear 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.