South Carolina Medicaid Preferred Drug List

 

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after February 1, 2012. 

 

FLUOROQUINOLONES

Preferred

Non-Preferred

LEVOFLOXACIN                                  Added as Preferred

AVELOX                                 Changed to Non-Preferred

 

OFLOXACIN                          Changed to Non-Preferred

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

Preferred

Non-Preferred

VIMOVO                                             Added as Preferred

FENOPROFEN                      Changed to Non-Preferred

 

MECLOFENAMATE             Changed to Non-Preferred

 

TOLMETIN                               Changed to Non-Preferred

NON-STIMULANT ADHD AGENTS

Preferred

Non-Preferred

STRATTERA                                             Added as Preferred

 

INTUNIV                                                       Added as Preferred

 

PROTEASE INHIBITOR FOR HEPATITIS

Preferred

Non-Preferred

INCIVEK*                                             Added as Preferred

 

VICTRELIS*                                          Added as Preferred

 

* Clinical edit applies.

 

 

 

SMOKING CESSATION PRODUCTS

Preferred

Non-Preferred

CHANTIX                                             Added as Preferred

NICOTROL NS (NASAL)              Added as Non-Preferred

NICOTINE GUM                                 Added as Preferred

NICOTROL (INHALATION)      Added as Non-Preferred

NICOTINE PATCH                              Added as Preferred

 

BUPROPION SR                                 Added as Preferred

 

NICOTINE LOZENGE                         Added as Preferred

 
   

TOPICAL ACNE AGENTS

Preferred

Non-Preferred

AZELEX                                                  Added as Preferred

ADAPALENE                          Changed to Non-Preferred

CLINDAGEL                                           Added as Preferred

CLINDAMYCIN/BENZOYL PEROXIDE

                                                Changed to Non-Preferred

CLINDAMYCIN PHOSPHATE              Added as Preferred

 

GENERIC ERYTHROMYCIN PREPS     Added as Preferred

 

GENERIC SULFACETAMIDE-SULFUR PREPS

                                                               Added as Preferred

 

 

 

TOPICAL STEROIDS

Preferred

Non-Preferred

ALCLOMETASONE DIPROPIONATE  Added as Preferred

DESONATE                                Added as Non-Preferred

CAPEX SHAMPOO                               Added as Preferred

DESONIL + PLUS                       Added as Non-Preferred

DERMA-SMOOTHE-FS                        Added as Preferred

PEDIADERM HC / TA               Added as Non-Preferred

DESONIDE                                            Added as Preferred

VERDESO                                   Added as Non-Preferred

HYDROCORTISONE                             Added as Preferred

CORDRAN TAPE                       Added as Non-Preferred

CLODERM                                             Added as Preferred

CUTIVATE LOTION                   Added as Non-Preferred

FLUOCINOLONE ACETONIDE            Added as Preferred

LOCOID LIPOCREAM               Added as Non-Preferred

FLUTICASONE PROPIONATE             Added as Preferred

LUXIQ                                        Added as Non-Preferred

HYDROCORTISONE BUTYRATE         Added as Preferred

MOMEXIN                                Added as Non-Preferred

HYDROCORTISONE VALERATE         Added as Preferred

PANDEL                                     Added as Non-Preferred

MOMETASONE FUROATE                 Added as Preferred

PREDNICARBATE                     Added as Non-Preferred

BETAMETHASONE DIPROPIONATE  Added as Preferred

AMCINONIDE                           Added as Non-Preferred

BETAMETHASONE VALERATE           Added as Preferred

DIFLORASONE DIACETATE     Added as Non-Preferred

DESOXIMETASONE                             Added as Preferred

HALOG                                       Added as Non-Preferred

FLUOCINONIDE                                   Added as Preferred

KENALOG AEROSOL                Added as Non-Preferred

FLUOCINONIDE EMOLLIENT             Added as Preferred

VANOS                                       Added as Non-Preferred

FLUOCINONIDE-E                                Added as Preferred

CLOBEX                                     Added as Non-Preferred

TRIAMCINOLONE ACETONIDE          Added as Preferred

HALAC                                       Added as Non-Preferred

CLOBETASOL EMOLLIENT                 Added as Preferred

HALONATE                               Added as Non-Preferred

CLOBETASOL PROPIONATE              Added as Preferred

OLUX-E                                      Added as Non-Preferred

HALOBETASOL PROPIONATE           Added as Preferred

 

 

 

Prescribers are encouraged to write prescriptions for preferred products.  However, if it is determined that a patient’s condition requires therapy with a non-preferred drug, the prescriber (or his/her designated office personnel) is responsible for initiating the Prior Authorization (PA) request.  A prospective, approved PA request will prevent rejection of prescription claims at the pharmacy due to the PA requirement.

 

PA requests may be submitted online, via telephone, or fax to the Magellan Medicaid Administration Clinical Call Center.  To access the WebPA tool for online PA submission, visit http://southcarolina.fhsc.com , click on "Prescribers", then "WebPA".  New users will need to click on “UAC” in the right hand corner to request a User ID and Password.  The toll-free telephone and fax numbers for the Clinical Call Center are 866-247-1181 and 888-603-7696 , respectively.  The Magellan Clinical Call Center telephone number is reserved for use by healthcare professionals and should not be provided to beneficiaries.  Magellan’s Beneficiary Call Centertelephone number for Pharmacy Services is 800-834-2680 .

 

Any questions regarding this bulletin should be directed to your Program Representative in the Division of Pharmacy Services at (803) 898-2876.

Report Fraud