Actoplus

Each option offers medicare supplemental coverage for participants who are eligible for medicare and traditional primary coverage for participants who aren't yet eligible for medicare and actos. Effective October 2, 2006, the Alabama Medicaid Agency will update our Preferred Drug List PDL ; to reflect recent Pharmacy and Therapeutics P&T ; recommendations as well as quarterly updates: October 2, 2006 PDL Additions October 2, 2006 PDL Deletions * Actos Combipatch Actiplus Met Flonase Advair HFA Nasarel Avandaryl Wellbutrin XL Humalog Rozerem * denotes that these products will no longer be preferred but are still covered by Alabama Medicaid and will require Prior Authorization PA ; . In addition to drug changes, the Agency will be updating its criteria for the following class es ; : Estrogens. Prior therapies must include prescribed and PDL preferred agents. For any drug classes where stable therapy applies, supporting documentation is required of the source of the medication meeting stable therapy requirements. Examples of acceptable documentation include pharmacy profile printouts, prescription copies, copies of the medical record medication list or progress notes documenting strength and quantity consistent with consecutive therapy timeframes. Stable therapy does not include medication samples or manufacturer vouchers. The PA request form and criteria booklet, as well as a link for a new PA request form that can be completed and submitted electronically online, can be found on the Agency website at medicaid.alabama.gov and should be utilized by the prescribing physician or the dispensing pharmacy when requesting a PA. Please note that the Electronic PA system reviews drug claims in most PDL classes as the pharmacist bills a point of sale claim, and a PA may be automatically assigned no hard copy PA needed ; if the patient meets the appropriate criteria. Hard copy PA requests may be faxed or mailed to: Health Information Designs HID ; Medicaid Pharmacy Administrative Services P. O. Box 3210 Auburn, AL 36832-3210 Fax: 1-800-748-0116 Phone: 1-800-748-0130 Incomplete PA requests or those failing to meet Medicaid criteria will be denied. If the prescribing physician believes medical justification should be considered, the physician must document this on the form or submit a written letter of medical justification along with the prior authorization form. Additional information may be requested. Staff physicians will review this information. Policy questions concerning this provider notice should be directed to the Pharmacy Program at 334 ; 242-5050. Questions regarding prior authorization procedures should be directed to the HID help desk at 1-800-748-0130. Please note the Agency's new web address: medicaid.alabama.gov September 15, 2006!