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Medicaid Preferred Drug List Changes New Prior Authorization Requirements for Vusion Ointment and Xo

Medicaid Preferred Drug List Changes New Prior Authorization Requirements for Vusion Ointment and Xo 2025

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The North Carolina Medicaid Pharmacy Newsletter (September 2011) outlines significant updates including changes to the Preferred Drug List, new prior authorization requirements for specific medications, termination of inactive provider numbers, limitations on vacation supply prescriptions, and updates on drug rebate manufacturers. It also discusses the transition of N.C. Health Choice claims processing and upcoming changes to co-payments for recipients. The document emphasizes the importance of reporting fraud and abuse within the Medicaid system.

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What is a preferred drug list for Medicaid?

A PDL is a list of medications that Medicaid will cover the cost for without the need to request a prior authorization (PA). PDLs are comprised of medications that either are generic formulations or are the result of price negotiations between the pharmaceutical companies and Medicaid.

What is a Medicaid preferred drug list?

A Preferred Drug List (PDL) is a list of outpatient drugs that states encourage providers to prescribe over others, as a mechanism to negotiate higher supplemental rebates. A state may attach a higher copay or require prior authorization for drugs not on the PDL.

What is considered a preferred drug?

Preferred Brand-Name Drugs These are drugs for which generic equivalents are not available. They have been in the market for a time and are widely accepted. Express Scripts has arranged a significant discount on these drugs. They cost more than generics, but less than nonpreferred brand-name drugs.

Why would Medicaid deny a prescription?

Medicaid patients are increasingly facing procedural prescription denials, meaning their health plans refuse to cover medications for administrative reasons like early refills, plan limits on pill amounts or prior authorization rules.

Is estrogen cream covered by Medicaid?

Most commercial insurance plans, Medicare, and Medicaid cover estrogen products. However, your out-of-pocket costs can still be high, because brand-name estrogen products are often covered in tiers with the highest copays.