Apple Health (Medicaid): 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 June 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

Diabetes Drugs -- SGLT-2 Inhibitors

Synjardy XR®

Added as Non-Preferred, not subject to TIP/DAW-1 override.

Multiple Sclerosis

Ocrevus®

Added as Non-Preferred, subject to DAW-1 override.

NSAIDs

Entire class

Client must try all preferred drugs before a non-preferred drug will be authorized unless contraindicated or not clinically appropriate.

Skeletal Muscle Relaxants

Entire class

Client must try all preferred drugs before a non-preferred drug will be authorized unless contraindicated or not clinically appropriate.

Skeletal Muscle Relaxants

cyclobenzaprine 5mg

Preferred

Skeletal Muscle Relaxants

cyclobenzaprine 7.5mg

Non-preferred, subject to TIP/DAW-1 override.

Skeletal Muscle Relaxants

cyclobenzaprine 10mg

Preferred

 

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