PDL 2 2012
User Manual: PDL-2
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1 Medicaid Preferred Drug Lists (PDLs) for Mental Health and Substance Abuse Key: * = therapeutic classes or treatment category included in PDL States have designed, approved and implemented use of "Preferred Drug Lists" (or "PDLs") as an evolved method of encouraging or emphasizing the prescribing, dispensing and reimbursement of certain specific prescription drugs for particular categories or classes of treatment. The design of PDLs was initiated by several individual state Medicaid programs, including Florida, Michigan and Connecticut; such lists were first approved by CMS in mid2003. As of early 2012, at least 48 states use some type of PDL. The table below provides a summary of state practices affecting several types of drugs used in relation to mental health and substance abuse. The table includes links to individual state PDL documents when available, to allow a detailed examination or comparison of state practices. In some states the same or similar PDL is applied to public employee health plans or additional state-only health coverage. Prepublication edition. Compiled by the NCSL Health Program – February 2012 State & Links to PDLs Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana CNS Stimulants (ADD/ADHD) * * Antidepressants * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Antipsychotics Sedatives & Hypnotics Anticonvulsants Long Acting Narcotics (Methadone) Bipolar Specific Medications Alcohol Abuse Agents Smoking Cessation Anxiolytics * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 2 Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *1 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * State does not have or does not publish a PDL- Please see footnote for additional information * * * * * * * * * * * * * * * * * * * * * * * * State does not have or does not publish a PDL- Please see footnote for additional information * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 3 Guam Puerto Rico U.S. Virgin Islands Territory does not have or does not publish a PDL Territory does not have or does not publish a PDL Territory does not have or does not publish a PDL NOTES 1 - Hypnotics only Unlike private-sector, "closed" drug formularies, preferred drug lists provide a mechanism to place specific prescription products, by brand and/or generic name. The technique commonly includes two listed categories: “preferred” and “non-preferred.” In most cases, both brand name and generic products may be listed as preferred. In the case of Medicaid PDLs – both preferred and non-preferred drugs are available to patients. However, non-preferred drugs may require an additional step: 1) certification by the physician or other prescriber that the specific brand name product is required by the patient and cannot be substituted; 2) prior approval or pre-authorization by the state agency or 3) certification that a preferred drug was prescribed earlier and was not medically effective. In some states, preferred drugs may be subject to a state-negotiated supplemental rebate, payable by the manufacturer to the state agency (and not affecting the individual patient.) The inclusion (or exclusion) of a treatment class within a PDL does not in itself define whether all, most or only some drugs to treat the condition are considered preferred. Authors and Research This report and 50-state data was researched and compiled by Kara Hinkley, Research Analyst, under the direction of Richard Cauchi, Program Director, for the NCSL Health Program-Denver. It supplements and partly replaces an earlier report on State Preferred Dug Lists, by Richard Cauchi, published in 2008 and last updated in 2010. MEDICAID PDL LINKS: (links were accurate as of date of publication but are subject to change by the state agency) ALABAMA: http://www.medicaid.state.al.us/documents/program-RX/Drug_Info/3J-3l_PDL_List_Therapeutic_10-1-10.pdf (Medicaid) ALASKA: http://hss.state.ak.us/dhcs/pdl/drug_lists_pdl/druglist.pdf (Medicaid) 4 ARIZONA: http://www.azahcccs.gov/members/Downloads/FFSformulary_members.pdf (Medicaid- Fee for-service) ARKANSAS: https://www.medicaid.state.ar.us/internetsolution/provider/pharm/scripinfo.aspx#overview (Medicaid) CALIFORNIA: http://files.medical.ca.gov/pubsdoco/manual/man_query.asp?wSearch=(%23filename+drugscdl*.doc+OR+%23filename+drugscdl*.zip)&wFLogo=Contract+Drugs+List&wFLogo H=52&wFLogoW=516&wAlt=Contract+Drugs+List&wPath=N (Medicaid) COLORADO: http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheader=application%2Fpdf&blobheadername1=ContentDisposition&blobheadername2=MDT-Type&blobheadervalue1=inline%3B+filename%3D139%2F1015%2FMicrosoft+Word+-+PDL+effective+--202+143.pdf&blobheadervalue2=abinary%3B+charset%3DUTF-8&blobkey=id&blobtable=MungoBlobs&blobwhere=1251756172832&ssbinary=true (Medicaid) CONNECTICUT: https://www.ctdssmap.com/CTPortal/Portals/0/StaticContent/Publications/CT_PDL_medicaid.pdf (Medicaid) DELAWARE: http://www.dmap.state.de.us/information/Pharmacy/DEM%20PDL.pdf (Medicaid) FLORIDA: http://ahca.myflorida.com/medicaid/Prescribed_Drug/pharm_thera/pdf/120229_PDL_updated_022912.pdf (Medicaid) GEORGIA: http://dch.georgia.gov/vgn/images/portal/cit_1210/53/24/181080014PDL_by_Drug_Class-Effective_2-1-12.pdf (Medicaid) HAWAII: http://www.ohanahealthplan.com/WCAssets/hawaii/assets/OHANA_ABBREVIATED_PDL.pdf (Medicaid) IDAHO: http://www.healthandwelfare.idaho.gov/Medical/PrescriptionDrugs/tabid/119/Default.aspx (Medicaid) ILLINOIS: http://www.hfs.illinois.gov/assets/pdl.pdf (Medicaid) INDIANA: http://www.indianapbm.com/Downloads/Master%20Preferred%20Drug%20List%20updated%2004-01-2011.pdf (Medicaid) IOWA: http://www.iowamedicaidpdl.com/uploads/c4/um/c4um_T1gPjIRC_3G0QGoXw/IA_PDL_REPORT_112012.pdf (Medicaid) KANSAS: http://www.kdheks.gov/hcf/pharmacy/download/PDLList.pdf (Medicaid) KENTUCKY: http://kentucky.wellcare.com/WCAssets/kentucky/assets/WellCare_KY_Medicaid_PDL_tagged_approved090111.pdf (Medicaid) LOUISIANA: http://www.lamedicaid.com/provweb1/pharmacy/preferred_08_01.htm (Medicaid) 5 MAINE: http://www.mainecarepdl.org/index.pl/pdlfiles (Medicaid) MARYLAND: http://www.providersynergies.com/services/documents/MDM_PDL.pdf (Medicaid) MASSACHUSETTS: https://masshealthdruglist.ehs.state.ma.us/MHDL/pubthera.do (Medicaid) MICHIGAN: https://michigan.fhsc.com/Downloads/PDL_20120201b.pdf (Medicaid) MINNESOTA: http://www.dhs.state.mn.us/main/groups/business_partners/documents/pub/dhs_id_016922.pdf (Medicaid) MISSISSIPPI: http://www.medicaid.ms.gov/Documents/Pharmacy/PDLArchive/PreferredDrugListEffective070108.pdf (Medicaid) MISSOURI: http://dss.mo.gov/mhd/cs/pharmacy/pages/clinedit.htm - MO HealthNet is continuing to compile an extensive state-specific PDL. Therapy classes included thus far include smoking cessation, Serotonin-Norepinephrine Reuptake Inhibitors (SNRI), Sedative Hypnotics, Psychotropic Medications, Long Acting Narcotics (methadone), Atypical Antipsychotics, and ADHD Therapy. MONTANA: http://medicaidprovider.hhs.mt.gov/pdf/mtuupdatedpdl02062012.pdf (Medicaid) NEBRASKA: https://nebraska.fhsc.com/RemoteFiles/PROD/PDL/NE_PDL-20120213a.pdf (Medicaid) NEVADA: http://www.medicaid.nv.gov/Downloads/provider/NV_PDL_20111102.pdf (Medicaid) NEW HAMPSHIRE: http://www.dhhs.nh.gov/ombp/pharmacy/documents/preferred.pdf (Medicaid) NEW JERSEY: http://www.americhoice.com/edocs/en/physicians/pdls/pdl_acnj.pdf (Medicaid) NEW MEXICO: http://www.nm-formulary.com/pls/fred/fred_display_formulary.main?site_id=1 (NMRx) NEW YORK: https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PDL.pdf (Medicaid) NORTH CAROLINA: http://www.ncdhhs.gov/dma/pharmacy/PDL.pdf (Medicaid & Health Choice) NORTH DAKOTA: The North Dakota Legislature attempted to create a Medicaid PDL through a 2005 bill, SB 2284 (Sen. Krebsbach) Medicaid Prior Authorization Program (NDMA/NDHA). The Senate defeated SB 2284 (Medicaid Preferred Drug List). OHIO: http://jfs.ohio.gov/ohp/bhpp/PDLQuicklist.pdf (Medicaid) 6 OKLAHOMA: Oklahomans can create a login on ePocrates to view the SoonerCare drug list here: http://okhca.org/providers.aspx?id=672&menu=74. OREGON: http://www.dhs.state.or.us/policy/healthplan/guides/pharmacy/pdl.pdf (Medicaid- Fee for-service) PENNSYLVANIA: http://www.providersynergies.com/services/documents/PAM_PDL.pdf Medicaid) RHODE ISLAND: http://www.dhs.ri.gov/Portals/0/Uploads/Documents/Public/Pharmacy/pdl_list.pdf (Medicaid) SOUTH CAROLINA: http://southcarolina.fhsc.com/Downloads/provider/SCpdl_listing_20120201.pdf (Medicaid) SOUTH DAKOTA: As of February 2012, The South Dakota Department of Social Services (DSS) is issuing this Request for Information (RFI) to solicit information, recommendations and advice regarding a Medicaid Preferred Drug List and Supplemental Rebate program: http://dss.sd.gov/PDL%20RFI%20DRAFT%20FINAL.2.10.pdf TENNESSEE: https://tnm.rxportal.sxc.com/rxclaim/TNM/PDLtable.htm (Medicaid) TEXAS: http://www.txvendordrug.com/downloads/pdl/TXMPDL_012312.pdf (Medicaid) UTAH: http://health.utah.gov/medicaid/pharmacy/PDL/files/Utah%20Medicaid%20PDL%20021612.pdf (Medicaid) VERMONT: http://dvha.vermont.gov/for-providers/2012-02-vt-pdl-quicklist-vt-february-7-2012-final.pdf (Medicaid) VIRGINIA: http://www.dmas.virginia.gov/downloads/pdfs/pharm-pdl_201201_lctr.pdf (Medicaid) WASHINGTON: http://www.rx.wa.gov/documents/washingtonpdl.pdf (Medicaid) WEST VIRGINIA: http://www.dhhr.wv.gov/bms/Pharmacy/dur/Documents/Preferred%20Drug%20List/WV%20PDL01252012%20v2012%204a.pdf (Medicaid) WISCONSIN: https://www.forwardhealth.wi.gov/WIPortal/Tab/42/icscontent/provider/medicaid/pharmacy/resources.htm.spage (Medicaid) WYOMING: Wyomingites can locate the Wyoming Medicaid Formulary on ePocrates by signing up here: http://www.health.wyo.gov/healthcarefin/pharmacy/WyomingMedicaidFormularyonEpocrates.html DISTRICT OF COLUMBIA: https://dc.fhsc.com/downloads/providers/DCRx_PDL_listing.pdf (Medicaid) EXAMPLES OF STATE-ONLY PDLs 7
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