LETTER TO PRESCRIBING PRACTITIONERS
September 20, 2007
Dear Prescribing
Practitioner:
RE: PDL # 07-02
Attached is the
complete, most current listing of drugs on the Medicaid Prior Authorization (PA)
Process' Preferred Drug List (PDL) "07-02." The listing includes
preferred drugs and those drugs requiring prior authorization. This list
will be effective October 1, 2007.
The PA process,
in accordance with the program's "Continuity of Care" policy, does not impact
original prescriptions (or refills) issued by a prescribing practitioner prior
to effective PA dates of drugs as they are added to the PA process as long
as they are within the 5 refills and 6-month program limits. An
educational alert will notify the pharmacist that prescriptions (and their
refills) will require a new prescription and prior authorization, if the
prescription life exceeds six months or the refill exceeds the 5 refill limit.
The educational alert will state, "NEW RX WILL REQUIRE PA AFTER (DATE)."
This issuance of the PDL includes the COX-2
selective agent, Celebrex®. Please be reminded that several years ago, the FDA
issued a Public Health Advisory, which stated that use of a COX-2 selective
agent may be associated with an increased risk of serious cardiovascular events,
especially when they are used for long periods of time or in very high-risk
settings.
As a result of this Public Health Advisory
and to help ensure the safety and well being of Medicaid patients, our current
policy requires the prescribing practitioner to include:
- The condition being treated with the COX-2 selective
agent by indicating the ICD-9-CM diagnosis code of the treated condition
(e.g. Osteoarthritis - 715.0) on all new prescriptions written for a COX-2
selective agent; and
- The reason a COX-2 selective agent is used rather than
a non-selective NSAID (e.g. treatment failure or history of a GI bleed).
The ICD-9-CM diagnosis code and the
rationale for the choice of a COX-2 must be noted in the prescriber's
handwriting. A rubber stamp notation is not acceptable.
A prescription written for a COX-2 selective
agent that includes a diagnosis code without a rationale for using the COX-2
selective agent will be set to process without an override when the following
criteria is met:
- Patient has current prescription for H2 receptor
antagonists;
- Patient has current prescription for proton pump
inhibitor;
- Patient has current prescription for warfarin;
- Patient has current prescriptions indicating chronic
use of oral steroids; or
- Patient is sixty years old or greater.
The goal is to
assure appropriate use of this COX-2 selective agent and allow pharmacy claims
to process when gastrointestinal risks appear likely with use of the
non-selective NSAIDs.
Information on
the Prior Authorization process, including the PDL and Prior Authorization
Request Form (copy is attached, Form RXPA01), is also available on the Louisiana
Medicaid website (www.lamedicaid.com).
This website will be updated when changes (additions or deletions) are made to
the PDL. The program may also utilize the provider remittance advices to notify
providers of PDL changes that must be implemented in short time frames.
The Department
has received inquiries that drug products requiring PA are not reimbursable by
Medicaid. Medicaid does reimburse for drug products requiring prior
authorization when the prior authorization process is followed.
Thank you for
your continued cooperation. We appreciate your participation in the Medicaid
Program.
Sincerely,
Jerry Phillips
Medicaid Director
MJT/alp
Attachments (2)
The above letter and the Preferred Drug
List are
also available in PDF format on the Downloadable
Forms and Files page.