Apple Health Fee-for-Service Preferred Drug List (PDL)

 

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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):

Drug Class

Drug Name

Change

Antiemetics

Granisol®

Removed from listing, no longer manufactured

Antiemetics

ondansetron ODT tablet

Removed EA requirement, only PDL rules apply

Antiemetics

Zofran ODT®

Removed EA requirement, only PDL rules apply

Long-Acting Opioids

Xtampza®

Non-Preferred, not subject to DAW-1 override

Multiple Sclerosis

Entire class

Client must have tried and failed, or is intolerant to, all preferred products before receiving a non-preferred product for the same indication.

Newer Anticoagulants

Entire class

Client must have tried and failed, or is intolerant to, all preferred products before receiving a non-preferred product for the same indication.

 

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