Apple Health: Washington Preferred Drug List (WPDL)

Washington State Health Care Authority sent this bulletin at 02/03/2017 04:19 PM PST
HCA Apple Health Medicaid

 

Dear Provider,

This is an update to a provider alert issued on January 31, 2017. This update contains additional changes to the Apple Health (Medicaid): Fee-for-Service Preferred Drug List (PDL).

Effective for claims with dates of service on and after March 1, 2017, the Health Care Authority (agency) will make the following changes to the Apple Health (Medicaid): Fee-for-Service PDL:

Drug Class

Drug Name

Change

Alzheimer’s

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.

Antiemetics

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.

Antiplatelets

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.

Attention Deficit/

Hyperactivity Disorder

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.

Atypical Antipsychotics

Entire class

Changed title of drug class to “Second Generation Antipsychotic Drugs.”

Atypical Antipsychotics

(Second Generation Antipsychotics)

Entire class

Client must have tried and failed, or is intolerant to, 3 preferred products for the same indication before receiving a non-preferred product.

Atypical Antipsychotics

(Second Generation Antipsychotics)

 

Aristada®

Preferred

Atypical Antipsychotics

(Second Generation Antipsychotics)

Invega Trinza®

Preferred

Atypical Antipsychotics

(Second Generation Antipsychotics)

Rexulti®

Preferred

Atypical Antipsychotics

(Second Generation Antipsychotics)

Vraylar®

Preferred

Long-Acting Insulins

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.

Multiple Sclerosis

Entire class

Clarifying try/fail statement:

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

Nasal Corticosteroids

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 Sedative Hypnotics

Entire class

Added subclasses. Removed all EA and PA requirements, only PDL rules apply. Client must have tried and failed, or is intolerant to, all preferred products before receiving a non-preferred product for the same indication.

Targeted Immune Modulators

Inflectra®

Added to class as non-preferred, unstudied, not subject to TIP/DAW.

Targeted Immune Modulators

Entire class

Removed all EA and PA requirements, only PDL rules apply. 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.