South Carolina Medicaid Preferred Drug List

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after April 9, 2012

TETRACYCLINES

Preferred

Non-Preferred

DOXYCYCLINE HYCLATE Added as Preferred

 

DOXYCYCLINE MONOHYDRATE (50, 100MG)

Added as Preferred

 

MINOCYCLINE Added as Preferred

 

TETRACYCLINE Added as Preferred

 

VIBRAMYCIN SUSPENSION Added as Preferred

 

VIBRAMYCIN SYRUP Added as Preferred

 
   

TOPICAL ACNE AGENTS

Preferred

Non-Preferred

AKNE-MYCIN

DIFFERIN Changed to Non-Preferred

AZELEX

EPIDUO Changed to Non-Preferred

BENZACLIN

 

BENZOYL PEROXIDE

 

CLINDAGEL

 

CLINDAMYCIN PHOSPHATE

 

ERYTHROMYCIN

 

TOPICAL ACNE AGENTS (continued)

Preferred

Non-Preferred

RETIN-A MICRO

 

SULFACETAMIDE/SULFUR/UREA

 

TRETINOIN

 

 

 

 

 

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 or concerns regarding this bulletin should be directed to your Program Representative in the Office of Physician, Pharmacy, and Enhanced Care Services at (803) 898-2876.

 

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