The Department of Human Services (Department) maintains a preferred drug list (PDL) to ensure that Medical Assistance (MA) program beneficiaries in the Fee-for-Service (FFS) delivery system have access to clinically effective medical care with an emphasis on quality, patient safety and optimal results from the drugs that are prescribed for them.
When considering medications for MA beneficiaries, providers should try to choose drugs that are designated as preferred on the PDL. Drugs designated as non-preferred on the PDL remain available to MA beneficiaries when determined to be medically necessary (see non-preferred drug section below).
The drugs that are designated as preferred on the PDL are those drugs that are determined by the Pharmacy & Therapeutics Committee to be the best in a particular class based on: clinical effectiveness, safety and outcomes. When all drugs in a class are therapeutically equivalent, the cost of the drug, including rebates, will be considered. Some preferred drugs require clinical prior authorization to ensure appropriate use and patient safety.
Non-preferred drugs remain available to MA beneficiaries when found to be medically necessary. All drugs designated as non-preferred require prior authorization by the Department before the prescriptions can be dispensed at the pharmacy.
The Department has contracts with Goold Health Systems, A Change Healthcare Company to provide consultation and support for the PDL.
The latest version of the PDL can be found on the Goold Health Systems website. The Goold Health Systems provides information on the following: