South Carolina Medicaid Preferred Drug List

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after August 1, 2014. 

ANTIHISTAMINES, MINIMALLY SEDATING

Preferred Non-Preferred
Cetirizine Allegra®
Fexofenadine*† Clarinex®
Loratadine Claritin®
  Desloratadine
* Liquids and orally disintegrating formulations limited to Levocetirizine
patients age 12 and under Xyzal®
† Added as Preferred Zyrtec®

THIAZOLIDINEDIONES (TZDs)

Preferred Non-Preferred
Pioglitazone Actos®‡
  ActosPlus® Met‡
  ActosPlus® Met XR
  Avandamet®
  Avandaryl®
  Avandia®
 

 

THIAZOLIDINEDIONES (TZDs)  (continued)

Preferred Non-Preferred
  Duetact®‡
  Added as Non-Preferred
   

SULFONYLUREAS

Preferred Non-Preferred
Glimepiride Amaryl®
Glipizide Diabeta®
Glyburide* Glucotrol® / Glucotrol® XL
Glyburide/Metformin† Glucovance®
  Glynase PresTab®
* Caution : Glyburide may result in a higher risk of severe Metformin/Glipizide (Metaglip)
prolonged Hypoglycemia in older adults  
Added as Preferred  
   

BRONCHODILATORS BETA AGONIST, SHORT ACTING NEBULIZERS

Preferred Non-Preferred
Albuterol Nebulizer Inhalation† Xopenex®
Added as Preferred  

 

ANTICOAGULANTS, ORAL

Preferred Non-Preferred
Warfarin Coumadin®
Pradaxa® Jantoven®
Eliquis®†  
Xarelto®  
Added as Preferred  
   

PROTON PUMP INHIBITORS (PPIs) 

Preferred Non-Preferred
Omeprazole Aciphex®
Pantoprazole Dexilant®
Nexium® Suspension† Esomeprazole Strontium‡
  Lansoprazole
  Nexium®
  Prilosec®
  Prevacid®
  Protonix®
 

PROTON PUMP INHIBITORS (PPIs)   (continued)

Preferred Non-Preferred
*Disintegrating Lansoprazole will continue to be Zegerid®
available without PA for patients age 12 and under  
† Added as Preferred ‡ Added as Non-Preferred
   

SMOKING CESSATION

Preferred Non-Preferred
Bupropion SR NicoDerm®CQ Patch
Chantix® / Dose Pack Nicorette®
Nicotine Gum Nicorette® Lozenge
Nicotine Lozenge Nicotrol® Inhalation
Nicotine Patch Nicotrol® NS Nasal
  Zyban®
   

ANTIBIOTICS, INHALED

Preferred Non-Preferred
Bethkis®† Cayston®
TOBI Inhalation®† TOBI® Podhaler™
  Tobramycin Solution Inhalation
† Added as Preferred  
 

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, 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 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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