Washington Preferred Drug List (WPDL)

HCA Apple Health Medicaid

 

Dear Provider,

Effective for claims with dates of service on and after September 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

Antiemetic

Aloxi®

Non-Preferred, EA no longer required

Antiemetic

Anzemet®

Non-Preferred, EA no longer required

Antiemetic

Granisol®

Non-Preferred, EA no longer required

Antiemetic

Granisetron

Preferred, EA no longer required

Antiemetic

Varubi®

Non-Preferred, not subject to TIP or DAW-1 override

Atypical Antipsychotics

Nuplazid®

Non-Preferred, not subject to DAW-1 override

Direct-Acting Antiviral Agents for Hepatitis C

 

Epclusa®

Non-Preferred, not subject to TIP or DAW-1 override and PA required

Long-Acting Beta-Agonist – Long Acting Muscarinic Agent Combinations

(LABA – LAMA)

Bevespi Aerosphere®

Non-Preferred, not subject to TIP or DAW-1 override and EA required

Long Acting Insulins

Levemir Flexpen®

Removed

Multiple Sclerosis Drugs

Zinbryta™

Non-Preferred, not subject to TIP or DAW-1 override

Newer Anticoagulants

Eliquis®

Removed PA requirement

Newer Anticoagulants

Pradaxa®

Removed PA requirement

Newer Anticoagulants

Savaysa®

Removed PA requirement

Newer Anticoagulants

Xarelto®

Removed PA requirement

Newer Anticoagulants

Xarelto Starter Pack®

Removed PA requirement

Newer Diabetic

alogliptin benzoate

Non-Preferred, PA required

Overactive Bladder

 

darifenacin hydrobromide ER

Non-Preferred

PCSK-9 Inhibitors

Repatha Pushtronex®

Preferred, PA required

Second Generation Antidepressants

citalopram HBR solution

Non-Preferred

Second Generation Antidepressants

escitalopram solution

Non-Preferred

Second Generation Antidepressants

fluoxetine HCl tablet

Non-Preferred

Second Generation Antidepressants

fluvoxamine ER

Non-Preferred

Second Generation Antidepressants

sertraline HCl solution

Non-Preferred

Second Generation Antidepressants

venlafaxine ER tablets

Non-Preferred

Statin-type Cholesterol Lowering Agents

rosuvastatin

Non-Preferred, not subject to DAW-1 override

Targeted Immune Modulators

Orencia Clickjet®

Non-Preferred, EA required

Targeted Immune Modulators

Xeljanz XR®

Non-Preferred, not subject to TIP or DAW-1 override

Triptans

frovatriptan

Non-Preferred

Triptans

Zembrace Symtouch®

Non-Preferred, not subject to TIP or DAW-1 override

For more details, see the agency’s Apple Health (Medicaid) Fee-For-Service Preferred Drug List.