Apple Health (Medicaid): Fee-for-service Preferred Drug List (PDL)

Washington State Health Care Authority sent this bulletin at 10/06/2016 10:18 AM PDT

Apple Health (Medicaid): Provider Alert

Dear Provider,

Effective for claims with dates of service on and after November 1, 2016, the Health Care Authority (agency) will make the following changes to the Apple Health (Medicaid): Fee-for-service Preferred Drug List (PDL):

Drug Class	Drug Name	Change
ACE Inhibitors	Qbrelis®	New drug added. Non-Preferred, not subject to DAW-1 override
Direct-Acting Antiviral Agents for Hepatitis C	Viekira XR™	New drug added. Non-Preferred, not subject to DAW-1 override, and PA required
Long-Acting Muscarinic Agents (LAMA)	Spiriva Respimat®	EA no longer required, only PDL rules apply
Multiple Sclerosis Drugs	Lemtrada®	Studied
Multiple Sclerosis Drugs	Zinbryta®	Studied
Multiple Sclerosis Drugs	Plegridy®	Studied
Multiple Sclerosis Drugs	Plegridy® Pen	Studied
Multiple Sclerosis Drugs	Plegridy® Starter Pak	Studied
Nasal Corticosteroids	budesonide OTC	Preferred
Nasal Corticosteroids	budesonide RX	Non-Preferred
Nasal Corticosteroids	fluticasone propionate OTC	Preferred
Nasal Corticosteroids	fluticasone propionate RX	Non-Preferred
Nasal Corticosteroids	triamcinolone acetonide OTC	Preferred
Nasal Corticosteroids	triamcinolone acetonide RX	Non-Preferred
Second Generation Antidepressants	paroxetine ER	Non-Preferred
TIMs	Stelara® IV solution	New drug added. Non-Preferred, not subject to DAW-1 override or TIP

For more details, see the agency’s Apple Health Medicaid: Fee-for-service Preferred Drug List.

Please do not reply directly to this message. If you have feedback or questions, please visit the HCA website for contact information.

About Washington State Health Care Authority
HCA oversees the state’s top two health care purchasers — Washington Apple Health (Medicaid) and the Public Employee Benefits Board Program. We work with partners to help ensure Washingtonians have access to better health and better care at a lower cost. For more information, visit www.hca.wa.gov.

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