South Carolina Medicaid Preferred Drug List
The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after January 1, 2013.
ANTIDEPRESSANTS, OTHER |
|
Preferred |
Non-Preferred |
BUPROPION |
VENLAFAXINE ER TABS Changed to Non-Preferred |
BUPROPION SR |
|
BUPROPION XL |
|
MIRTAZAPINE |
|
NEFAZODONE |
|
PHENELZINE |
|
TRAZODONE |
|
VENLAFAXINE/VENLAFAXINE ER CAPS |
|
HEPATITIS C AGENTS |
|
Preferred |
Non-Preferred |
INCIVEK™ |
|
PEGASYS® & CONV PACK |
|
PEG-INTRON® & REDIPEN |
|
RIBAVIRIN |
|
VICTRELIS™ |
|
|
|
|
|
TOPICAL STEROIDS (VERY HIGH) |
|
Preferred |
Non-Preferred |
BETAMETHASONE DIPROPIONATE |
CLOBETASOL PROP FOAM† |
CLOBETASOL (Cream/Gel/Ointment/Solution) |
CLOBETASOL (Shampoo/Lotion) † |
CLOBETASOL EMOLLIENT |
|
HALOBETASOL PROPRIONATE |
†Changed to Non-Preferred |
TOPICAL STEROIDS (MEDIUM) |
|
Preferred |
Non-Preferred |
BETAMETHASONE VALERATE (Cream/Lotion) |
HYDROCORTISONE VALERATE (Ointment)† |
BETA-VAL (Cream/Lotion) |
FLUTICASONE PROP (Cream/Lotion)† |
HYDROCORTISONE BUTYRATE (Ointment/Solution) |
HYDROCORT BUTYRATE (Cream)† |
HYDROCORTISONE VALERATE (Cream/Solution) |
CLODERM† |
MOMETASONE FUROATE |
FLUOCINOLONE ACET (Cream/Ointment/Solution)† |
|
† Changed to Non-Preferred |
|
|
OPTHTHALMICS for ALLERGIC CONJUNCTIVITIS |
|
ALAWAY® OTC |
PATANOL® Changed to Non-Preferred |
ELESTAT® |
|
KETOTIFEN OTC |
|
PATADAY® |
|
ZADITOR® OTC |
|
The list above only reflects changes to the Preferred Drug List (PDL). To view the complete Preferred Drug List (PDL), please refer to our website http://southcarolina.fhsc.com.
Prescribers are strongly encouraged to write prescriptions for "preferred" products. However, if a prescriber deems that a patient’s clinical status requires therapy with a PA-required drug, the prescriber (or his/her designated office personnel) is responsible for initiating the PA request. A prospective, approved PA request will prevent rejection of prescription claims at the pharmacy due to the PA requirement.
All PA requests should be submitted via WebPA, telephone, or fax to the Magellan Medicaid Administration Clinical Call Center by the prescriber or the prescriber’s designated office personnel. To access the WebPA tool, visithttp://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 Medicaid Administration Clinical Call Center telephone number is reserved for use by healthcare professionals and should not be provided to beneficiaries. (Magellan Medicaid Administration’s SC Medicaid beneficiary call centertelephone number for Pharmacy Services is 800-
834-2680. Providers may furnish the beneficiary call center telephone number to Medicaid beneficiaries for Pharmacy Services-related issues only.)
A pharmacy claim submitted for a PA-required product that has not been approved for Medicaid reimbursement will reject. If this occurs, the pharmacist should contact the prescriber so that a determination can be made regarding whether a drug not requiring PA is clinically appropriate for the patient.
Questions regarding this bulletin should be directed to Magellan Medicaid Administration’s Call Center at 866-254-1669.