Changes to the Preferred Drug List

***Attention Pharmacy Providers***

The N.C. Medicaid Outpatient Pharmacy Program will implement changes to the Preferred Drug List (PDL) on November 14, 2012. The changes could affect pharmacy stocking needs, generic substitution, product substitution, and POS overrides.

BRAND MEDICATIONS NEWLY DESIGNATED AS NON-PREFERRED

The following brand name medications will be moved from Preferred to Non-Preferred status as of November 14, 2012, after which time you may dispense the generic product if available.

If generic equivalents are available and are Preferred, but the prescriber indicated “Medically Necessary” on the original prescription, prior approval is needed in order to continue on the Non-Preferred brand drug.

The POS message for non-preferred medications will say “NON-PDL DRUG; MD CALL ACS: 1-866-246-8505” to indicate patient needs to be switched to Preferred agent. If a medication requires prior authorization, the POS message will be “PA REQ. PRESCRBR CALL ACS: 1-866-246-8505”. If a Non-Preferred brand needs prior authorization for DAW-1, the message at the POS will be “PRESCRIBER MUST COMPLETE ADVERSE EVENT REPORT AT www.documentforsafety.org FOR PRIOR APPROVAL FOR BRAND NAME DRUGS (DAW-1)”. If a prescription exceeds the quantity limit, the POS message will be “CLAIM DENIED, PA LIMITS EXCEEDED”. If a medication is a non-preferred generic, you will receive the following POS message: “DISPENSE BRAND; GENERIC NON-PREFERRED”.

Cholesterol Lowering Agents

  • Generic atorvastatin, lovastatin, pravastatin, and simvastatin will be Preferred
  • Crestor will be Non-Preferred
  • Prior authorization criteria removed from this class --> “Meets PA Criteria” no longer applies when written on prescriptions

Fluoroquinolones

  • Avelox and ofloxacin will be Non-Preferred agents
  • Levofloxacin tablets will be Preferred

PPIs

  • Nexium will be a Non-Preferred agent
  • Generic lansoprazole OTC will be Preferred

Inhaled Corticosteroids

  • Pulmicort Respules (0.25 and 0.5 mg) will be Preferred over generic budesonide

Click here to view a PDF of the NC Medicaid Preferred Drug List (PDL)

Click here to view the Summary of Changes to the NC Medicaid PDL

Refer to www.ncmedicaidpbm.com for more information. Please assist your patients during this transition.

As always, thank you for your support in serving our Medicaid Community!

Patrick Johnson, Network Pharmacist, 1050 Revolution Mill Drive Studio 4, 336-235-0930 ext. 3319, 336-362-4025 (mobile)

Contact Us (336) 235-0930