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