Medicaid Preferred Drug List

In 2004, The Vendor Drug Program enforced the Medicaid Preferred Drug List (PDL). Medical products that are presently available to Medicaid members will remain to be accessible. The –preferred drugs list is a list of cost-effective medications covered by your prescription drug plan. It can be given minus the previous authorization, while non-preferred drugs will expect to present an original authorization.  Validity of the prior authorization is lasted only for a year and it can only be asked by the prescribing physician or an authorized staff of the physician.

The Pharmaceutical and Therapeutics (P&T) Committee prepares the proposals for the preferred drugs lists followed by Health and Human Services Commission. Medicaid provides a list of medications in various therapeutic classes for use in meeting the prescription medication needs of patients who are members. Each state has its own Medicaid Preferred Drug List. This list is meant for use with health plans and associated pharmaceutical companies. The Medicaid Clinical Drug Review Program monitors the prescribing protocols to guard long-term efficacy of a drug.

The PDL is split into categories of medications and furnishes a range of therapeutically efficient medical products for which the Medicaid program will allot payment without limitation.   Formulary Committee is assigned to base the safety and clinical usefulness of the PDL and should also consider economic information. Prior Authorization (PA) is needed if the drug is not listed in the assigned category. The Committee’s endeavour guarantees the drug therapy effect on the patient.

As Medicaid has a Preferred Drug List, patients must also be aware on how to use the PDL.  A printout of the modified Medicaid Preferred Drug List must be available every appointment with your health provider.  Request the physician to authorize a generic drug alternative, since all generics are believed to be a preferred medication. Buying generic drugs saves you money for its lower cost of your copayment for up to 30-day supply.  If there are other medicine brands other than what is prescribed for your medical term, the doctor must be requested to prescribe drug that is on the Medicaid Preferred Drug List; it will also trim down the co-pays as well.

Prescription medications are assigned within three tiers on the Preferred Drug List. Each tier is allotted a cost that is dictated by the Medicaid and pharmacy benefit plan.

Tier 1/Lower-cost generic has $10 for up to 30-day supply. Tier 1 medications are the lowest-cost option for patients.

Tier 2/Preferred brand-name drugs without a generic available have $35 for up to 30-day supply and it’s the patient’s midrange-cost option. If there’s no Tier 1 medication available the Tier 2 can be considered to treat a patient’s medical condition.

Tier 3/Non-preferred brand-name drugs without a generic have $55 for up to 30-day supply. It has the highest cost among the 3 Tiers.

The physician and the patient decide on health care and medication treatments using the Medicaid Preferred Drug List.

An updated list of the Medicaid Preferred Drug List can be accessed on your state’s Medicaid Department’s web site and can be downloaded as .PDF file, so make sure to have a PDF reader.