Translate to provide an exact translation of the website. You should not rely on Google™ The agendas are posted on the Web sites and open to the public. (See Appendix A for a detailed list of interviewees.) MAC Information; Quick Links. Celecoxib 100mg and 200mg diclofenac 1% gel (generic Voltaren) # diclofenac sodium EC/DR ibuprofen tablet Rx indomethacin capsule IR ketorolac (oral) # meloxicam tablet naproxen tablet (Naprosyn) sulindac # Voltaren 1% gel Rx #. UNIVERSAL PREFERRED DRUG LIST (For All Medicaid, MSCAN and CHIP Beneficiaries) Conduent’s SmartPA Pharmacy Application (SmartPA) is a proprietary electronic prior authorization system used for Medicaid fee for service claims. If a provider feels the call center determination was clinically unsound they are encouraged to contact the Pharmacy and Clinical Services Unit clinical staff at 573-751-6963. A Preferred Drug List Advisory Committee, composed of practicing physicians and pharmacists, ensures that extensive clinical review of drug products takes place. Humana – CareSource ® covers all medically necessary Medicaid-covered drugs at many pharmacies. To find a location near you, go to dss.mo.gov/dss_map/. Inferred Diagnosis based on medications: 90 days. Most drugs are identified as “preferred” or “non-preferred”. MO HealthNet utilizes a real-time prior authorization rules engine in order to approve medications for MO HealthNet participants when they meet certain criteria in their paid claim history. Virtually all pharmacy claims are processed online real-time. Some State of Missouri websites can be translated into many different languages using Google™ Translate, a third party service (the "Service") that provides automated computer The preferred drug list is arranged by drug therapeutic class and contains a subset of many, but not all, drugs on the Medicaid formulary. Beginning July 21, 2016, Texas Medicaid will start using an updated list of the Medicaid Preferred Drug List (PDL). Providing the service as a convenience is If there is still disagreement, the participant has a right to appeal the determination through the Fair Hearings Process, by writing the MO HealthNet Division Participant Services Unit (PSU), PO Box 3535, Jefferson City, MO 65102-3535 to request a hearing. PLEASE READ THIS DISCLAIMER CAREFULLY BEFORE USING THE SERVICE. 19 Dec 2019 … PDF download: New Drug List. PDL List of Preferred and Non-Preferred Agents. There are circumstances where the service does not translate correctly and/or where translations may not be possible, such Missouri Department of Social Services is an equal opportunity employer/program. The drugs listed in this PDL are intended to provide sufficient options to treat patients who require treatment with a drug from that Nebraska Medicaid Preferred Drug List with Prior Authorization Criteria PDL Updated March 1, 2019 Highlights indicated change from previous posting Unless otherwise specified, the listing of a particular brand or generic name includes all dosage forms of that drug. Hotline calls are completed within minutes and approvals immediately available in the point-of-sale system. CELECOXIB CAPSULES (CELEBREX) LIDOCAINE PATCH (LIDODERM)* RAMELTEON (ROZEREM)* Effective 2/28/2012 DICLOFENAC SODIUM DR 25MG, 50MG, 75MG TABLETS OXCARBAZEPINE (TRILEPTAL)* ZALEPLON (SONATA)* DICLOFENAC SODIUM. Preferred Drug List The PDL is a clinical guide of prescription drug products selected by WellCare's Pharmaceutical and Therapeutics (P&T) Committee based on a drug's efficacy, safety, side effects, pharmacokinetics, clinical literature and cost-effectiveness. If you have trouble finding your drug in the list, turn to the Index that begins on page <121>. Google Translate will not translate applications for programs such as Food Stamps, Medicaid, Temporary Assistance, Child Care and Child Support. including without limitation, indirect or consequential loss or damage arising from or in connection with use of the Google™ Translate Service. Generic drug: Lowercase in plain type . Medicaid Formulary Missouri 2020. A preferred drug is the agent in each functional therapeutic class that the agency would like prescribers to use in beginning therapy. Michigan Preferred Drug List (PDL)/Single PDL Effective 12/15/2020 Preferred Agents do not require prior authorization, except as noted in the chart at the bottom of the page 1 Prior Authorization Not Required for Beneficiaries Under the Age of 12. In each class, drugs are listed alphabetically by either brand name or generic name. Agents other than the preferred product(s) may be approved on the basis of medical necessity at any time. The Google™ Translate Service is offered as a convenience and is subject to applicable Google Terms of Service. The unit welcomes your questions, concerns and feedback. not an endorsement of the product or the results generated and nothing herein should be construed as such an approval or endorsement. Those choices are based on medical evidence and net program cost. The Apple Health Preferred Drug List (PDL) has products listed in groups by drug class. Illinois Medicaid Preferred Drug List Effective January 1, 2020 The Preferred Drug List (PDL) has products listed in groups by drug class, drug name, dosage form, and PDL status Multi-source drugs are listed by both brand and generic names when applicable Medicaid Preferred Drug List Page Content You may register to receive E-mail notification, when a new Preferred Drug List is posted to the Web site, by completing the form for Preferred Drug List E-Mail Notification Request . All edits are based first on medical evidence, and then net system cost is considered in development of the PDL. Google Translate will not translate applications for programs such as Food Stamps, Medicaid, Temporary Assistance, Child Care and Child Support. The unit monitors the call center wait times, and reacts by placing more technicians on the line at peak times to eliminate delays. Medicaid agencies must make payment for all Medicaid covered drugs when they are medically necessary. Claims not meeting criteria are rejected and must be overridden by the call center if necessary. Therapeutic categories not listed here are not part of the PDL and will continue to be covered as they always have for Maryland Medicaid participants. You should not rely on Google™ MO HealthNet is continuing the state specific Preferred Drug List and Clinical Edit processes. The Participant Services Unit may also be called toll free at 1-800-392-2161 or 573-751-6527 at the caller’s expense. not an endorsement of the product or the results generated and nothing herein should be construed as such an approval or endorsement. 2 Quantity limits apply – Refer to document at The Advisory Committee's review and recommendations are based on evidence-based clinical information, not cost. Preferred Drug List Announcement. Medicaid Preferred Drug List Options for States • 4 Michigan, Missouri, New Mexico, Ohio, Oregon, South Carolina, Texas, Virginia, Washington, and Wisconsin. The MO HealthNet fee for service program has a preferred drug list (PDL). Auxiliary aids and services are available upon request to individuals with disabilities. The content of State of Missouri websites originate in English. There are circumstances where the service does not translate correctly and/or where translations may not be possible, such That economic information will be paired with evidence based clinical information to arrive at preferred drug(s) in each functional therapeutic class. Preferred drugs are just that – drugs that we like our health partners to give you to treat an illness or health issue. including without limitation, indirect or consequential loss or damage arising from or in connection with use of the Google™ Translate Service. Medicaid Fee for Service Outpatient Pharmacy Program represents the preferred and non-preferred drug products as well as drugs requiring prior approval, quantity level limits, and therapy limits. NC Medicaid and Health Choice Preferred Drug List (PDL) effective Jan. 1, 2020 Nebraska Medicaid Preferred Drug List with Prior Authorization Criteria PDL Update June 1, 2020 Highlights indicated change from previous posting Unless otherwise specified, the listing of a particular brand or generic name includes all dosage forms of that drug. dss.mo.gov. The unit appreciates the provider commitment and support in servicing Missouri’s most vulnerable citizens. TDD/TTY: 800-735-2966, Relay Missouri: 711, Support Investigating Crimes Against Children, Make an Online Payment to Claims & Restitution, Online Invoicing for Residential Treatment & Children's Treatment Services, Provider Application for MO HealthNet Internet Access, Opioid Prescription Intervention (OPI) Program, Clinical Edit and Preferred Drug List Documents, https://pharmacy.services.conduent.com/mohealthnet/, http://s1.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13c70-20.pdf, Health Information Exchange Onboarding Program, Clinical information provided by the manufacturer, Evidence-based reviews developed by the Evidence-based Practice Center of Oregon Health Sciences University, University of Missouri-Kansas City Drug Information Center, Conduent State Health, LLC clinical staff. Neither the State of Missouri nor its employees accept liability for any inaccuracies or errors in the translation or liability for any loss, damage, or other problem, Alphabetical by drug name - Posted 12/02/20. The first column of the chart lists the generic name of the drug. By selecting a language from the Google Translate menu, the user accepts the legal implications of any misinterpretations or differences in the translation. For assistance call 1-855-373-4636 Or, visit your local Resource Center. In addition, some applications and/or services may not work as expected when translated. In addition, some applications and/or services may not work as expected when translated. Brand name drug: Uppercase in bold type . Drug … PDL Product Sept/October … 20 (20) -500. Should the lookback period be defined for a different period of time other than the standards below, it will be noted in the individual edit. Revised 12/22/2020: Preferred Drug List Quick Reference (Effective 1/1/2021) Diabetic Supply List Quick Reference (Effective 10/1/2020) Over-the-Counter Drugs. This means the agency solicits supplemental rebates from manufacturers. Claims meeting approval criteria require no call and occur over seventy-five percent of the time. translations of web pages. DO: Dose Optimization Program . The participant must contact RSU within 90 days of the date of the denial letter if they wish to request a hearing. PLEASE READ THIS DISCLAIMER CAREFULLY BEFORE USING THE SERVICE. Effective December 1, 2020. Additionally, you may subscribe to the agency's E-mail updates. Missouri Medicaid Drug Formulary. The agency’s two advisory groups, the Drug Prior Authorization Committee and the Drug Use Review Board have quarterly meetings. Clinical rules (edits) are established that look for those data elements, thus eliminating many calls for providers. MO HealthNet Division is continuing the state specific Preferred Drug List … quarterly meeting of the Drug Prior Authorization Committee and also posted on the … Medicaid Preferred Drug Lists (PDLs) for Mental Health and … le.utah.gov The average wait time at the call center is less than 2 minutes. If there are differences between the English content and its translation, the English content is always the most Lookbacks: PDL Guidelines; Preferred Drug Lists; Documentation of Medical Necessity / PDL Exception Request; P & T Committee; MAC Pricing. By selecting a language from the Google Translate menu, the user accepts the legal implications of any misinterpretations or differences in the translation. During peak times in the early and late afternoon wait times may be longer. The agency uses the following sources of medical information: A prescriber or pharmacy may call the agency hotline at 800-392-8030 or fax the request to 573-636-6470. translations of web pages. Each drug class on the PDL is reviewed annually. Non-preferred agents may be transparently approved through the agency’s SmartPAsm program after a trial of preferred agents paid for by MO HealthNet. Please see the approval criteria on the Pharmacy Clinical Edit and Preferred Drug List Documents page. Covered (BadgerCare Plus and Medicaid) (Effective 1/1/2018) Any concepts not specifically cited with published literature are based on For assistance call 1-855-373-4636 Or, visit your local Resource Center. That economic information will be paired with evidence based clinical information to arrive at preferred drug(s) in each functional therapeutic class. Health Plan of Nevada Medicaid is pleased to provide this Preferred Drug List (PDL) to be used when prescribing for patients covered by the pharmacy benefit plan offered by Health Plan of Nevada Medicaid. A pharmacy specific Web site is also available at https://pharmacy.services.conduent.com/mohealthnet/ . The List of Preferred Drugs that begins on page <1> gives you information about the drugs covered by Health Plan of Nevada Medicaid. The goal of the MO HealthNet Division and Clinical Services Unit is to provide clinically sound medication choices for MO HealthNet participants. As Google's translation is an automated service it may display interpretations that are an approximation of the website's original content. The MO HealthNet fee for service program has a preferred drug list (PDL). AL: Age Limit Restrictions . If the patient has more history relevant to the current request, the provider will need to contact the Pharmacy Helpdesk at 800-392-8030 or by fax at 573-636-6470. You may also address specific questions or concerns directly to the Pharmacy and Clinical Services Unit. Dec 15, 2016 … The following is the drug product list for the next phase of the PDL Providing the service as a convenience is Drugs designated as preferred have been selected for their efficaciousness, clinical significance, cost effectiveness and safety for Medicaid beneficiaries. Virginia Medicaid’s Preferred Drug List (PDL)/Common Core Formulary 7/1/20 3 | P a g e *Methadone Drugs Dolophine® Methadose® oral soln & tab methadone oral soln & tab *Methadone requires the completion of the Clinical SA form (Methadone SA Form) unless prescribed for neonatal abstinence syndrome for an infant under the age of one. translation. Preferred Drug List. as with certain file types, video content, and images. The claims are juried against other drug claims, participant diagnoses, and prior participant procedure claims. Auxiliary aids and services are available upon request to individuals with disabilities. If there are differences between the English content and its translation, the English content is always the most PDF download: New Drug List. The second column of MSCAN plans may/may not -have electronic PA functionality. The Pharmacy and Clinical Services Unit posts all program material on the agency’s Web site. MO HealthNet utilizes a real-time prior authorization rules engine in order to approve medications for MO HealthNet participants when they meet certain criteria in their paid claim history. accurate. Preferred Drug List Effective Date: 7/1/2019 (updated 8/10/2019) Only drugs that are part of the listed therapeutic categories are affected by the Medicaid Preferred Drug List (PDL). The PDL addresses certain drug classes: Some drug classes will not be reviewed for preferred status because of no and/or limited cost savings, if the class is all and/or mostly generic, or if there is low utilization in that class. The Statewide PDL includes only a subset of all Medicaid covered drugs. Preferred Drug List. Fax requests are usually completed in hours with a maximum of 24 hours during the normal work week. The State of Missouri has no control over the nature, content, and availability of the service, and accordingly, cannot guarantee the accuracy, reliability, or timeliness of the Preferred Drug List (PDL) - November 9, 2020 Please refer to the Additional Therapeutic Criteria Chart, Dosage Limitation List (red font indicates quantity/dosage limits apply) , and the Wyoming Medicaid 1%. Providers are encouraged to visit the agency’s Web site for the most current information. The following is a listing of therapeutic classes that have been implemented. TDD/TTY: 800-735-2966, Relay Missouri: 711, Support Investigating Crimes Against Children, Make an Online Payment to Claims & Restitution, Online Invoicing for Residential Treatment & Children's Treatment Services, Provider Application for MO HealthNet Internet Access, Opioid Prescription Intervention (OPI) Program, PDL List of Preferred and Non-Preferred Agents, ACE Inhibitors and ACE Inhibitors Diuretic Combinations PDL, ACE Inhibitors/Calcium Channel Blocker Combinations PDL, Acetaminophen Cumulative Dose Clinical Edit, Acne and Rosacea - Select Topical Agents Step Therapy Edit, ADHD Medication Prior Authorization Form - Children Less Than 6 Years Old, Alzheimer’s Agents & Cholinesterase Inhibitors PDLÂ, Angiotensin Receptor Blockers and Angiotensin Receptor Blocker/Diuretic Combinations PDL, Angiotensin Receptor Blocker-Calcium Channel Blocker Combinations PDL, Anticoagulants Agents: Oral and Subcutaneous PDL, Antiemetic 5-HT3, NK1 & Other Select Agents, Non-Injectable PDL, Antiemetic 5-HT3, NK1 Agents, Injectable PDL, Antifungal (Onychomycosis – Candidiasis) Agents Oral PDL, Antihistamine Decongestant Combination - Low Sedating, Anti-Migraine, Alternative Oral Agents PDL, Anti-Migraine, Serotonin (5-HT1) Receptor Agents PDL, Anti-Parkinsonism Non-Ergot Dopamine Agonists PDL, Antipsychotics – 2nd Generation (Atypicals) Reference Drug List, Atypical Antipsychotic Prior Authorization Form - Children Less Than 9 Years Old, Antiretrovirals, Treatment Reference Product List, Atopic Dermatitis Agents (Immunomodulators), Benzodiazepines (Select Oral) Clinical Edit, Benzoyl Peroxide-Antibiotic Combination PDL, Beta Adrenergic Agents – Short Acting PDL, Beta Adrenergic Blockers and Beta Adrenergic Blockers/Diuretic Combinations PDL, Biosimilar vs Reference Products Fiscal Edit, Calcitonin Gene-Related Peptide (CGRP) Inhibitors PDL, Calcium Channel Blockers (Dihydropyridines) PDL, Calcium Channel Blockers (Non-Dihydropyridines) PDL, Continuous Glucose Monitors (CGMs) Clinical Edit, Continuous Glucose Monitoring Device Prior Authorization, Cryopyrin-Associated Periodic Syndrome (CAPS) Agents PDL, Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Modulator Clinical Edit, Diabetic Supply Quantity Limit Fiscal Edit, Direct Renin Inhibitors and Combinations PDL, Duchenne Muscular Dystrophy (DMD) Clinical Edit, Electrolyte Depleters – Phosphate Lowering Agents PDL, Electrolyte Depleters – Potassium Lowering Agents PDL, Gastrointestinal(GI) Antibiotics – Oral PDL, Growth Hormones & Growth Hormone Releasing Factors, Select Agents PDL, Hereditary Angioedema Treatment Agents PDL, Homozygous Familial Hyperchloesterolemia (HFHC) Products PDL, Lambert-Eaton Myasthenic Syndrome (LEMS) Clinical Edit, Morphine Milligram Equivalent Accumulation, Multiple Sclerosis, Injectable Agents PDL, Opioid Prior Authorization Process for Prescribers, Opioid Prior Authorization Process for Pharmacy, Opioids, Combination Short-Acting Clinical Edit, Oral AntiDiabetic: Alpha - Glucosidase Inhibitors PDL, Parathyroid Hormone and Bone Resorption Suppression Related Agents Clinical Edit, Proprotein Convertase Subtilisin Kexin Type 9 (PCSK9) Binder PDL, Psychotropic Medications Polypharmacy Clinical Edit, Pulmonary Arterial Hypertension (PAH) Agents (Inhaled and Injectable) PDL, Pulmonary Arterial Hypertension (PAH) Agents – Oral Endothelin Receptor Antagonists (ETRAs), Pulmonary Arterial Hypertension (PAH) Agents – Oral Phosphodiesterase-5 (PDE5), Pulmonary Arterial Hypertension (PAH) Agents – Oral Prostacyclin Pathway Agonist, Sodium - Glucose Co - Transporter 2 (SGLT2) PDL, Statins (HMG Co-A Reductase Inhibitors) and Combination Products PDL, Targeted Immune Modulators, Interleukin-6 (IL-6) Receptor Inhibitors PDL, Targeted Immune Modulators, Interleukin (IL)-17 Antibody/IL17 Receptor Antagonists, IL-23 Inhibitors and IL-23/IL-12 Inhibitors PDL, Targeted Immune Modulators, Janus Kinase (JAK) Inhibitors PDL, Targeted Immune Modulators, Select Agents PDL, Targeted Immune Modulators, Tumor Necrosis Factor (TNF) Inhibitors PDL, Thiazolidinediones & Combination Agents PDL, Transmucosal Immediate Release Fentanyl (TIRF) Clinical Edit, Transthyretin-Mediated Amyloidosis (ATTR) Clinical Edit. Other Drug claims, participant diagnoses, and prior participant procedure claims Unit monitors the call center less... Is a listing of therapeutic classes that have been implemented < 121 > manage the List, to. Reacts by placing more technicians on the agency 's E-mail updates brand name or generic name the. You may subscribe to the Index that begins on page < 121 > drugs that we like our missouri medicaid preferred drug list to! The Google Translate menu, the user accepts the legal implications of any misinterpretations or in. The lookbacks outlined below will apply to the Pharmacy Clinical edits and Preferred Drug List ( PDL.! Of Social Services is an equal opportunity employer/program directly to the Pharmacy and Clinical Edit processes if are! 21, 2016, Texas Medicaid will start using an updated List of covered drugs through a Preferred Drug the! By law ) necessary Medicaid-covered drugs at many pharmacies open to the transparent lookback period auxiliary and. An updated List of interviewees. technicians on the basis of medical Necessity / Exception... Any time Committee 's review and recommendations are based on evidence-based Clinical information, not cost rejected and must overridden. Healthnet will continue to reimburse for all medications whose manufacturers have entered into the federal program! Be transparently approved through the agency ’ s expense any time and/or prior authorization 1/1/2021 ) Diabetic Supply Quick. In English, the English content and its translation, the lookbacks outlined below will apply to the Pharmacy Clinical. A hearing or, visit your local Resource center the Advisory Committee 's review and recommendations are based on! Unit monitors the call center wait times, and reacts by placing more technicians on the line at times... Lookbacks outlined below will apply to the agency ’ s expense Missouri websites originate English. 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