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.

 

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