Provider Notice Issued 01/08/2020

Date:    January 8, 2020
 
To:       All Medical Assistance Program Providers         
 
Re:      Managed Care Organization Grandfathering Clause for Certain Drugs      
 
 
This notice provides additional guidance relating to the Department’s managed care organizations’ (MCOs) adoption of the Department’s Preferred Drug List (PDL) beginning January 1, 2020. As part of the MCOs’ transition to the Department’s PDL, patients will be allowed to continue existing drug therapies in specified drug classes, if the current drug is changing to non-preferred status.    
 
By informational notice dated December 19, 2019, providers were advised that beginning January 1, 2020, all MCOs will be required to adopt the Department’s PDL. The MCOs will align their drug coverage with the Department’s so that they and the Department’s fee-for-service program have the same preferred and non-preferred products listed on their PDLs.  
 
Participants currently enrolled in an MCO and stabilized on medications in the drug classes found on the attached list will be grandfathered for an initial one-year period. After the initial one-year period, renewals may be granted if the patient is still on the medication and still stable. Each MCO is responsible for devising a strategy to implement this policy. 
 
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565, or to the applicable MCO.
 
 
 
Doug Elwell
Medicaid Director
 
 
 
ADHD / ANTI-NARCOLEPSY AGENTS: AMPHETAMINES
ADHD / ANTI-NARCOLEPSY AGENTS: MISC
ADHD / ANTI-NARCOLEPSY AGENTS: STIMULANTS
ANTIASTHMATIC AND BRONCHODILATOR AGENTS: ADRENERGIC COMBINATIONS
ANTIASTHMATIC AND BRONCHODILATOR AGENTS: ANTICHOLINERGICS
ANTIASTHMATIC AND BRONCHODILATOR AGENTS: BETA ADRENERGICS
ANTIASTHMATIC AND BRONCHODILATOR AGENTS: LEUKOTRIENE MODULATORS
ANTIASTHMATIC AND BRONCHODILATOR AGENTS: MISC
ANTIASTHMATIC AND BRONCHODILATOR AGENTS: MONOCLONAL ANTIBODIES
ANTIASTHMATIC AND BRONCHODILATOR AGENTS: STEROID INHALANTS
ANTICOAGULANTS: DIRECT FACTOR XA INHIBITORS & MISC
ANTICOAGULANTS: HEPARIN AND HEPARINOID-LIKE AGENTS
ANTICONVULSANTS
ANTIDEPRESSANTS: MISC
ANTIDEPRESSANTS: SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIs)
ANTIDEPRESSANTS: SELECTIVE SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITOR (SNRIs)
ANTIDIABETICS: COMBINATIONS
ANTIDIABETICS: DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS
ANTIDIABETICS: INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS)
ANTIDIABETICS: INSULIN
ANTIDIABETICS: MISC
ANTIDIABETICS: SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS
ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES: ALKYLATING AGENTS
ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES: ANTIMETABOLITES
ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES: ANTINEOPLASTIC - ANTIBODIES
ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES: ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS
ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES: ANTINEOPLASTIC ANTIBIOTICS
ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES: ANTINEOPLASTIC ENZYME INHIBITORS
ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES: CHEMOTHERAPY RESCUE / ANTIDOTE AGENTS
ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES: MISC
ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES: MITOTIC INHIBITORS
ANTIPARKINSON AND RELATED THERAPY AGENTS
ANTIPSYCHOTICS / ANTIMANIC AGENTS: BENZISOXAZOLES
ANTIPSYCHOTICS / ANTIMANIC AGENTS: DIBENZAPINES
ANTIPSYCHOTICS / ANTIMANIC AGENTS: MISC
ANTIPSYCHOTICS / ANTIMANIC AGENTS: QUINOLINONE DERIVATIVES
ANTIVIRALS: ANTIRETROVIRALS (HIV)
ANTIVIRALS: HEPATITIS B AGENTS
ANTIVIRALS: HEPATITIS C AGENTS
CARDIOVASCULAR AGENTS - ANTIHYPERTENSIVES: MISC
CARDIOVASCULAR AGENTS - CARDIOTONICS: PHOSPHODIESTERASE INHIBITORS
CARDIOVASCULAR AGENTS: ANTIANGINAL AGENTS
CARDIOVASCULAR AGENTS: ANTIARRHYTHMICS
CARDIOVASCULAR AGENTS: PULMONARY HYPERTENSION
GASTROINTESTINAL AGENTS: INFLAMMATORY BOWEL AGENTS
GASTROINTESTINAL AGENTS: MISC
HEMATOLOGICAL AGENTS: ANTIHEMOPHILIC PRODUCTS
HEMATOLOGICAL AGENTS: PLATELET AGGREGATION INHIBITORS
IMMUNOSUPPRESSIVE AGENTS
PROGESTINS
PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS: ANTIDEMENTIA AGENTS
PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS: MISC
PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS: MULTIPLE SCLEROSIS AGENTS
RESPIRATORY AGENTS: CYSTIC FIBROSIS AGENTS
RESPIRATORY AGENTS: MISC
TUMOR NECROSIS FACTOR ALPHA INHIBITORS AND MISC IMMUNOSUPPRESSIVES
URINARY ANTISPASMODICS
LEVOCARNITINE
THALOMID
REVLIMID
 

Notices

 

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