South Carolina Medicaid Preferred Drug List

 

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after July 22, 2013. 

LAXATIVES & CATHARTICS

Preferred

Non-Preferred

MILK OF MAGNESIA†

COLYTE, GoLYTELY, NuLYTELY®‡

MAGNESIUM CITRATE†

KRISTALOSE®‡

LACTULOSE†

MOVIPREP®‡

PEG 3350/ELECTROLYTE†

OSMOPREP®‡

MiraLAX OTC†

PEG 3350 OTC‡

 

PEG 3350 with FLAVOR PACKS‡

Added as Preferred

Added as Non-Preferred

ANTIHYPERTENSIVES, SYMPATHOLYTICS 

Preferred

Non-Preferred

CLONIDINE, ORAL†

CATAPRES, ORAL‡

GUANFACINE, ORAL†

CLONIDINE, TRANSDERMAL‡

METHYLDOPA, ORAL†

CLORPRES‡

CATAPRES-TTS®, TRANSDERMAL†

METHYLDOPA/HCTZ‡

 

RESERPINE‡

Added as Preferred

Added as Non-Preferred

 

 

 

ANTIPARASITICS, TOPICAL

Preferred

Non-Preferred

PERMETHRIN, OTC†

EURAX®, CREAM/LOTION‡

ULESFIA®†

LINDANE‡

PERMETHRIN 5% CREAM†

MALATHION‡

 

NATROBA™‡

 

OVIDE®‡

 

SKLICE®‡

 

SPINOSAD‡

Added as Preferred

Added as Non-Preferred

BETA AGONIST AGENTS, SHORT ACTING ORAL AGENTS

Preferred

Non-Preferred

ALBUTEROL SYRUP†

ALBUTEROL TABLET (ER)‡

ALBUTEROL IR TABLET†

METAPROTERENOL, TABLET/SYRUP‡

 

TERBUTALINE TABLET‡

Added as Preferred

Added as Non-Preferred

NEUROPATHIC PAIN

GABAPENTIN†

GRALISE®‡

LYRICA®†

HORIZANT®‡

SAVELLA®†

LIDODERM® PATCH‡

 

NEURONTIN®‡

 

QUTENZA®‡

Added as Preferred

Added as Non-Preferred

ANTIPSYCHOTICS, ORAL 

Preferred

Non-Preferred

CLOZAPINE ODT

GEODON®                             Changed to Non-Preferred

FANAPT®

 

FAZACLO®

 

OLANZAPINE                                        Added as Preferred

 

LATUDA®                                                       Added as Preferred

 

RISPERIDONE

 

QUETIAPINE

 

SAPHRIS®

 

SEROQUEL XR®

 

ZIPRASIDONE CAP                              Added as Preferred

 

BRONCHODILATORS, BETA AGONIST SHORT ACTING INHALERS

PROVENTIL® HFA

VENTOLIN® HFA                   Changed to Non-Preferred

PROAIR® HFA

 

 

 

BROCHODILATORS, BETA AGONIST LONG ACTING INHALERS

FORADIL®

SEREVENT® DISKUS             Changed to Non-Preferred

SEDATIVE HYPNOTICS

TEMAZEPAM

 

ZOLPIDEM IR

 

CHLORAL HYDRATE*                          Added as Preferred

 

*Covered for children 0 – 12 years of age ONLY

 

IMMUNOMODULATORS, ATOPIC DERMATITIS

ELIDEL®

PROTOPIC®                           Changed to Non-Preferred

 

 

The list above only reflects changes to the PDL.  To view the complete 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.   This bulletin affects the policy for fee-for-service Medicaid and Medical Home Networks (MHN). please contact the appropriate Managed Care Organization (MCO) for their coverage policy.  Thank you for your continued support of the South Carolina Medicaid program.

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