Changes to the SCDHHS Preferred Drug List Effective July 1, 2016

PROVIDER ALERT

Beginning with dates of service on or after July 1, 2016, the following changes will become effective for the South Carolina Department of Health and Human Services (SCDHHS) Preferred Drug List (PDL).  

OTIC ANTIBIOTICS

Preferred

Non-Preferred

 

Ofloxacin†

 

Moved to Non-Preferred

ANTIBIOTICS, TOPICAL

Preferred

Non-Preferred

 

Altabax®†

 

Mupirocin Cream†

 

Moved to Non-Preferred

ANTIVIRALS, TOPICAL

Preferred

Non-Preferred

Zovirax Cream‡

Acyclovir Ointment†

Added to Preferred

Moved to Non-Preferred

HYPOGLYCEMICS, METFORMIN

Preferred

Non-Preferred

 

Fortamet®/Metformin ER

 

Glumetza®/Metformin ER

ACNE AGENTS, TOPICAL (RETINOIDS)

Preferred

Non-Preferred

Retin A gel/cream‡

Retin-A Micro® - pump†

 

Tretinoin†

‡ Added to Preferred

† Moved to Non-Preferred

ACNE AGENTS, TOPICAL (SODIUM SULFACETAMIDE/SULFUR)

Preferred

Non-Preferred

Sulfacetamide Sodium 10% cleanser

Klaron

 

Ovace/Ovace Plus

 

Avar

 

Clarifoam

 

Claris

 

Plexion

 

Rosanil

 

Rosula

 

Sumadan

 

Sumaxin

 

Zencia

 

Generic Sodium Sulfacetamide/Sulfur Preparations

EPINEPHRINE (INJECTABLES)

Preferred

Non-Preferred

Adrenaclick/generic (autoinjector)‡

 

Moved to Preferred

 

EMERGENCY TREATMENT: OPIOID OVERDOSE

Preferred

Non-Preferred

Narcan Nasal Spray

Evzio

Naloxone Vial/Syringe

 

ANTIPSYCHOTICS, INJECTABLES

Preferred

Non-Preferred

Abilify Maintena®‡

 

Added to Preferred

 

PULMONARY ARTERIAL HYPERTENSION AGENTS, ORAL

Preferred

Non-Preferred

Tracleer®‡

 

Added to Preferred

 

NSAIDs, ORAL

Preferred

Non-Preferred

 

Diclofenac Potassium†

 

Diflunisal†

 

Etodolac†

 

Flurbiprofen†

 

Indomethacin Cap SR†

 

Ketoprofen†

 

Naproxen Sodium†

 

Oxaprozin†

 

Moved to Non-Preferred

ANTICOAGULANTS, SUBCUTANEOUS

Preferred

Non-Preferred

Fondaparinux‡

Arixtra®†

Added as Preferred

† Moved to Non-Preferred

INSULINS

Preferred

Non-Preferred

 

Novolin N, R, 70/30†

 

Moved to Non-Preferred

 

This alert applies to pharmacy providers, other medical professionals and members of the public. To view the complete PDL, please visit the Magellan website at http://southcarolina.fhsc.com/providers/pdl.asp .

 

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.     

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