About the Program

General Information:

• What is a Preferred Drug List?
• The PDL is a list of prescription medications within a therapeutic class determined to be effective which would be Medicaid’s first choice when prescribing for Medicaid patients.

Under a PDL program:

• All currently approved drugs remain available
• Preferred drugs require no special authorization
• Non-preferred drugs will require a prescriber’s documentation of medical necessity
• Certain groups of recipients based on age or other criteria may be exempt from the PDL requirements

How are drugs placed on the PDL?

• The Alaska Medicaid Pharmacy and Therapeutics (P&T) Committee will be responsible for determining the most effective drug or reference drug to be placed on the Preferred Drug List
• Drugs in specified drug classes are approved for the PDL based on safety, clinical efficacy, and cost

The Advantages of a PDL:

• The PDL ensures continued patient care while reducing the expenditure growth of the pharmacy program through supplemental rebate Agreements.
• All drugs currently covered will be available to Medicaid patients.
• Non-preferred drugs will require a prescriber's documentation of medical necessity.

Exemptions

• Certain groups of recipients based on age or other criteria may be exempt from the PDL requirements.
• The PDL will be phased in by sets of drug classes. Each set will include approximately five drug classes.

Criteria for non-PDL drug approval

• The prescriber will determine and document that the non-PDL drug is medically necessary. The exact criteria for this approval is to be determined by therapeutic class by the Pharmacy and Therapeutics Committee.

Provider Notification

• Providers will be notified in advance through this Website and mailings.
• The Alaska PDL processing for the first set of therapeutic classes will start by early 2004. At this time pharmacies will be notified with alerts but claims will not deny.
• Full Implementation:
  • The first therapeutic class will be fully implemented 60 to 90 days after the pharmacy alerts are active. When providers have been notified that the therapeutic class is in effect, individual drugs must be on the PDL List, determined to be medically necessary, or exempt from the PDL