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Apple Health (Medicaid): Provider Alert
Dear Provider,
Effective for claims with dates of service on and after January 1, 2017, the Health Care Authority (agency) will make the following changes to the Apple Health (Medicaid): Fee-for-Service Preferred Drug List (PDL):
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Drug Class
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Drug Name
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Change
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Antiemetics
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Granisol®
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Removed from listing, no longer manufactured
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Antiemetics
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ondansetron ODT tablet
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Removed EA requirement, only PDL rules apply
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Antiemetics
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Zofran ODT®
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Removed EA requirement, only PDL rules apply
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Long-Acting Opioids
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Xtampza®
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Non-Preferred, not subject to DAW-1 override
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Multiple Sclerosis
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Entire class
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Client must have tried and failed, or is intolerant to, all preferred products before receiving a non-preferred product for the same indication.
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Newer Anticoagulants
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Entire class
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Client must have tried and failed, or is intolerant to, all preferred products before receiving a non-preferred product for the same indication.
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For more details, see the agency’s Apple Health Medicaid: Fee–for-Service Preferred Drug List.
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