Find resources that can help you get the care you need. R414-60B-5. STATE OF UTAH, MEDICAID CARVE-OUT..... 13 EXCLUDED SERVICES ... We are pleased to provide the 2020 Molina Healthcare of Utah Preferred Drug List (Formulary) as a useful reference and informational tool. This document can assist medical providers in selecting clinically-appropriate and cost-effective products for their patients. Introduction. The Utah Administrative Code is currently undergoing a transition to adminrules.utah.gov. These nominations are then given to the Director for selection and appointment. To transition to a single PDL, Washington submitted two State Plan Amendments – one for the single PDL and one to include managed care plans in its supplemental rebate contracts through a multi-state purchasing pool for drugs on the PDL. (9) When a vacancy occurs on the committee, the Director shall appoint a replacement for the unexpired term of the vacating member. We are pleased to provide the 2019 Molina Healthcare of Utah Preferred Drug List (CHIP Formulary) as a useful reference and informational tool. (a) represent the majority vote at meetings in which a majority of voting members are present; and, (b) include votes by at least one committee member from the group identified in Subsection R414-60B-5(3) and one member from the group identified in Subsection R414-60B-5(4). Over-the-Counter drugs. For questions regarding the content or application of rules under Title R414, please contact the promulgating agency (Health, Health Care Financing, Coverage and Reimbursement Policy). Medicaid covers over-the-counter drugs when the drug is listed on the Utah Medicaid Over-the-Counter Drug List attachment to the Pharmacy Services Provider Manual, incorporated by reference in Section R414-1-5. Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain Utah Controlled Substance Database. The drugs listed in the UnitedHealthcare Community Plan PDL have been reviewed and approved by the Pharmacy and Therapeutics Committee. R414-60B-3. (1) Upon the recommendation of the Pharmacy and Therapeutics (P&T) Committee, DMHF pharmacy staff select the therapeutic classes and select the most clinically effective and cost effective drug or drugs within each class. Nevertheless, a prior authorization may apply if set by the Drug Utilization Review Board (DURB). The Utah Medicaid program offers comprehensive health benefits, including everything from your prescriptions to long-term hospital stays. Who is Eligible for Medicaid? Contact. R414. We are pleased to provide the 2020 Molina Healthcare of Utah Preferred Drug List (Formulary) as a useful reference and informational tool. Taylorsville, UT 84129-2128 To qualify, these individuals must meet income and other eligibility requirements. NOTE TO RULE FILING AGENCIES: Use the RTF version for submitting rule changes. Molina Healthcare covers all medically necessary Medicaid-covered medications. SaltLake City, UTAH 84130. Office of Administrative Rules Molina … The P&T Committee manager shall conduct meetings if the chairperson is not present. DMHF has the option of making the appointments renewable. Department of Vermont Health Access. Washington also added and amended contracts with a number of vendors to ensure the Medicaid agency and managed care plans had access to the same … Usted tiene que enviar la queja dentro de los 60 días de la fecha cuando se enteróde ella. (7) An individual considered for nomination must demonstrate no direct connection to and must be independent of the pharmaceutical manufacturing industry. If you have an NDC, please check the NDC lookup on the EOHHS healthcare portal to determine coverage. More information about the SSDC can be found at their website. For information and assistance with prescription drugs, call toll-free: 877-358-8797. In the State of Utah, drugs that are automatically covered under Medicaid are listed on the State-approved Preferred Drug List (PDL). R414-60B-7. Salt Lake City, UT 84114-1007 Utah Medicaid Over-the-Counter Drug List Footnotes Last Modified January 1, 2019 * PA Critera Forms ** † Brand Required Over Generic. Pharmacy Help Desk: 1-877-209-1264, Provider PA Help Desk: 1-877-207-1126 Salt Lake City, UTAH 84130 UHC_Civil_Rights@uhc.com Usted tiene que enviar la queja dentro de los 60 días de la fecha cuando se enteró de ella. (7) P&T Committee meetings shall be open to the public except when meeting in executive session. Program Access Requirements. These files are provided in PDF format. This document can assist medical providers in selecting clinically-appropriate and cost-effective products for their patients. To use a non-preferred drug, the Medication Coverage Exception Request must be used. NOTE: For a list of rules that have been made effective since January 1, 2020, please see the codification segue page. Preferred drugs within a chosen therapeutic class are selected based on clinical evidence of safety, efficacy, and effectiveness. Health, Health Care Financing, Coverage and Reimbursement Policy. Si noestá de acuerdo con la decisión, tiene 15 días para solicitar que la consideremos de nuevo. Criteria for a Non-preferred Prior Authorization (NPA) is established by the Department in consultation with the P&T Committee. The Ohio Department of Medicaid is implementing a Unified Preferred Drug List (UPDL) on January 1st, 2020 that will encompass the entire Medicaid population regardless of enrollment in Managed Care or Fee for Service (FFS). We also use a preferred drug list (PDL). this PDL are intended to provide sufficient options to treat patients who require treatment with a drug from that pharmacologic or therapeutic class. The Preferred Drug List (PDL) is a listing of therapeutic classes and associated drugs that are managed by the Medicaid Fee-for-Service Pharmacy and Therapeutics Committee. Clinical and Cost-Related Factors. Hours: 8:00 am - 5:00 pm, M-F. Utah.gov Home | Utah.gov Terms of Use | Utah.gov Privacy Policy | Utah.gov Accessibility Policy | Translate Utah.govCopyright © 2017 State of Utah - All rights reserved. Title: Preferred Drug List Utah Medicaid Author: Bryan S. Larson Created Date: 1/9/2019 2:27:26 PM (a) If there are no recommendations within 30 days of a request, DMHF may submit a list of potential candidates to professional organizations for consideration. For information about prescription drugs covered by UDOH, visit the UDOH website: Utah Medicaid Pharmacy Website UHC_Civil_Rights@uhc.com. Drugs that fall into a class on the Statewide PDL are generally designated as non-preferred until they are reviewed by the P&T committee. Medicaid’s Ability to Prioritize Lowest-Net-Cost Drugs Could Lead to Savings Medicaid has access to rebate information for all drugs covered, which can be used to compile the net cost of each drug after rebates. The Statewide PDL will be updated annually, but that will not preclude beneficiaries from getting new drugs that come to market as long as they meet CMS criteria for a Medicaid covered drug. We also use a preferred drug list (PDL). Pharmacy Customer Service is available at (855) 869-4769, 24 hours/7days a week/365 days a year. Salt Lake City, UT 84116, Early and Periodic Screening, Diagnostic and Treatment, Living Well with Chronic Conditions Program, Medicaid for Long-Term Care and Waiver Programs, Utah’s Premium Partnership for Health Insurance, UAMRP (Utah Access Monitoring Review Plan), 1115 Demonstration Application – Per Capita Cap Public Hearings, Aged Dental and Porcelain Crown Amendment Public Hearings, Behavioral Health Services for Adults with Serious Mental Illness Public Hearings, Dental Benefits for Individuals with Blindness or Disabilities. Medicaid Preferred Drug List (PDL) Savings Since 2007, the Utah Department of Health (UDOH) Division of Medicaid and Health Financ - ing has employed a Preferred Drug List (PDL) program with prior authorization requirements for non-preferred drugs. Pages: 3-87 Pages: 88-91 Page: 92 Page: 93 Page: 94 Pages: 95-96 Search Tip: Use the keyboard shortcut Ctrl+F to open the Find menu. All preferred drugs and diabetic supplies are NDC specific. Program Access Requirements. During the 2007 legislative session, the Utah State Legislature passed Senate Bill 42 allowing Medicaid to adopt a preferred drug list (PDL). Quantity limits: Sometimes UnitedHealthcare Community Plan of Virginia – Medicaid and FAMIS limits the amount of a drug you can get. R414-60B-6. This document can assist medical providers in selecting clinically-appropriate and cost-effective products for their patients. Learn about SelectHealth Community Care. The chairperson may serve consecutive terms if reelected by the committee. (5) In an emergency situation for a prior authorization needed outside of normal business hours, a 72-hour supply of a non-preferred drug may be dispensed and the Department shall issue an NPA for the 72-hour supply on the next business day. To view the Molina Healthcare of Utah Medicaid/ CHIP Drug List, click below: UT Medicaid Preferred Drug List UT CHIP Preferred Drug List. Utah belongs to The Sovereign States Drug Consortium (SSDC), a collaborative group of Medicaid states. Compounds. For the purposes of the Preferred Drug List, psychotropic medications are defined as This PDL is in compliance with the final and approved legislative action to Article 10, Substitute A as amended which modified Section 40-21-1 of the General Laws in Chapter 40-21 The drugs have been selected to provide the (6) P&T Committee meetings shall occur at least quarterly. (10) P&T Committee members serve at the discretion of the DMHF Director. During the 2009 legislative session, the State Legislature approved SB 87, which authorizes Utah Medicaid to require a Prior Authorization for non-preferred drugs. R414-60-2. Further quantity requests shall be subject to all NPA requirements. Utilization of this information through a statewide PDL for FFS and the ACOs could save the Medicaid program up to $3.4 million a year. (5) The P&T Committee chairperson shall conduct all meetings. (3) A prior authorization is not placed on any preferred drugs under Section R414-60B-4. (1) The P&T Committee functions as a professional and technical advisory board to DMHF in the formulation of a PDL. Products not listed may or may not be subject to clinical prior authorization requirements or other coverage limitations. Collectively members are focused on providing quality pharmaceutical care while controlling costs. (4) For NPA requests submitted during normal business hours, Monday through Friday, 8 a.m. to 5 p.m., the prior authorization system shall provide either telephone or fax approval or denial within 24 hours of the receipt of the request. Medicaid Preferred Drug List • Utah Medicaid’s PDL Implementation - Continued –Emergency 72-hour supply approved for non-business days or for after hour prescriptions –Specific classes are excluded from PDL (26.18-2.4) 13 It also includes full case management for mental health, starting with evaluations and moving through therapy, medication, and psychological treatment. Si usted necesita ayuda con su queja, por favor llame al. Pursuant to HB 437, passed during the 2016 General Session, Utah Medicaid began placing psychotropic drugs on the Preferred Drug List (PDL) effective July 1, 2016. Si no está de acuerdo con la decisión, tiene 15 días para solicitar que la consideremos de nuevo. this Preferred Drug List (PDL) to be used when prescribing for patients covered by the pharmacy benefit plan offered by UnitedHealthcare Community Plan. Type a word/medication to find in the document R414-60-11. (6) Up to two non-voting ad hoc specialists participate on the committee at the committee's invitation. Healthy U Medicaid. Se le enviará la decisión en un plazo de 30 días. Prescription Drugs & Medication. Brand Preferred Drug List Calendar Covered Over-the-Counter Diabetic Supplies Drug Utilization Review (DUR) Board Enrollment Forms High Investment Drug Carve Out List Maintenance Drug List Opioid Prescribing Guidelines Pharmacy Lock-In Program Pharmacy Providers Directory Point of Sale NCPDP Codes Prenatal Vitamin List For information and assistance with prescription drugs, call toll-free: 877-358-8797. (2) DMHF staff request nominations for appointees from professional organizations within the state. The Utah Administrative Code is the body of all effective administrative rules as compiled and organized by the Division of Administrative Rules (see Subsection 63G-3-102(5); see also Sections 63G-3-701 and 702). (2) The Preferred Drug List is authorized under Section 26-18-2.4. This document can assist medical providers in selecting clinically-appropriate and cost-effective products for their patients. To view the Molina Healthcare of Utah Medicaid/ CHIP Drug List, click below: UT Medicaid Preferred Drug List UT CHIP Preferred Drug List. UHC_Civil_Rights@uhc.com. Client Eligibility Requirements. All managed care plans and the fee-for-service program serving Apple Health clients use this PDL. Molina Healthcare covers all medically necessary Medicaid-covered medications. The Utah PDL is not an all inclusive list of Utah Medicaid covered outpatient pharmaceutical agents. Oklahoma’s Medicaid Agency The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. Date of Enactment or Last Substantive Amendment, Authorizing, Implemented, or Interpreted Law, http://www.utah.gov/government/agencylist.html, https://rules.utah.gov/help-rules-who-to-contact/. P&T Committee Responsibilities and Functions. Definitions. At its discretion, DMHF establishes and implements the scope and therapeutic classes of drugs. P&T Committee Composition and Membership Requirements. (1) The Division of Medicaid and Health Financing (DMHF) has established a Preferred Drug List (PDL) to operate within the pharmacy program and at the Division's discretion. The DMHF Director shall appoint the members of the P&T Committee for a two-year term. Prescription Drugs & Medication. South Carolina Medicaid Preferred Drug List Submitted January 11, 2012 - 4:20pm The following revisions to the Preferred Drug List (PDL) are effective with dates of … Introduction and Authority. Updates about the PDL implementation process will be provided through the MIB, and on this website. The Medicaid Preferred Drug List continues to expand on a monthly basis. If you disagree with the decision, you have 15 calendar days to ask us to look at it again. When a medical professional wishes to request coverage for a non-preferred drug, they will need to fill out the Utah Medicaid Prior Authorization Form in order to make their request. (b) If there are no willing nominees for appointment from professional organizations, the Director may seek recommendations from DMHF staff. Pennsylvania-Medicaid; Texas; Washington; For more information, read our First Quarter 2021 Preferred Drug List Update. University of Utah Health Plans 6053 Fashion Square Drive, Suite 110 Murray, UT 84107 Phone: 801-587-6480 288 North 1460 West ‡ Quantity Limits Apply. (2) The prescriber must obtain prior authorization from the Department to dispense drugs designated as "non-preferred" in each class, through the Department's current prior authorization system. (3) The P&T Committee consists of one physician from each of the following specialty areas: (4) The P&T Committee consists of one pharmacist from each of the following areas: (5) DMHF shall appoint one voting committee manager. Phone: (801) 957-7110 If you cannot open a file, please click on the image below to install the required plugin. Not all medications will be added, modified or deleted in each state, so please check the state’s PDL for a state-specific list of preferred drugs. For information about prescription drugs covered by UDOH, visit the UDOH website: Utah Medicaid Pharmacy Website Hours of Operation: Monday-Friday (Excluding Holidays) 7:45am - 4:30pm These are the drugs that we prefer our providers to prescribe. Salt Lake City, UTAH 84130 • Correo electrónico: UHC_Civil_Rights@uhc.com Usted también puede presentar una queja acerca de sus derechos civiles ante el Departamento de Salud y Servicios Humanos de los Estados Unidos, Oficina de Derechos Civiles, haciendo por: Internet: Sitio en Imternet para la Oficina de Derechos Civiles en You must send the complaintwithin60 calendar days of when you found out about it. Medicaid Preferred Drug List • Utah’s PDL Differs from other Medicaid PDLs – 86% of other states include Antipsychotics – 90% of other states include Antidepressants – 90% of other states include Stimulants – 72% of other states include Anticonvulsants – 34% of other states include Anxiolytics A PDL is established for certain therapeutic classes of drugs and is available through the point of sale system of any Medicaid provider. ODM pharmacy staff and leaders from the Managed Care Plans collaborated together in clinical, technical, and communications-based workgroups to help ensure a smooth … Utah Medicaid Preferred Drug List - Effective November 1, 2020 Preferred Drugs Status Type Last Update Limits Mandatory 3-Month Brand Required Additional Note Celecoxib Preferred Generic 09/01/20 diclofenac gel Preferred Generic 11/01/19 diclofenac Na DR 50, 75mg Preferred Generic 01/01/12 diclofenac Na SR Preferred Generic 01/01/13 diclofenac potassium Preferred Generic 07/01/12 … Medicaid is a state/federal program that pays for medical services for low-income pregnant women, children, individuals who are elderly or have a disability, parents and women with breast or cervical cancer. Please refer to the the Utah Medicaid Pharmacy Provider Manual for more information. The PA requirement became effective May 18, 2009. 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