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Pharmacy
Preferred Drug List (PDL)
Archived PDL Phase-In Implementation Schedules
PDL Phase-In Implementation Schedule (Revised 4/3/06)
PDF (7 KB)
| Therapeutic Class |
Prior Authorization Required Date |
| Wisconsin Medicaid and
BadgerCare Update 2006-32 |
| ACE Inhibitors |
April 3, 2006 |
| ACE Inhibitors/Calcium Channel Blocker Combinations |
| Acne Agents |
| Analgesics, Narcotics |
| Angiotensin Receptor Blockers |
| Anticoagulants, Injectables |
| Anticonvulsants |
| Antidepressants, Other |
| Antihistamines, Nonsedating |
| Antimigraine, Triptans |
| Agents for Benign Prostatic Hyperplasia (BPH) |
| Beta Blockers |
| Bone Resorption Suppression and Related Agents |
| Calcium Channel Blocking Agents |
| Erythropoiesis Stimulating Proteins |
| Fluoroquinolones |
| Glucocorticoids, Inhaled |
| Growth Hormone |
| Hepatitis C Agents |
| Hypoglycemics, Meglitinides |
| Hypoglycemics, Thiazolidinediones |
| Multiple Sclerosis Agents |
| Otics, Antibiotics |
| Phosphate Binders and Related Agents |
| Proton Pump Inhibitors |
| Sedative Hypnotics |
| Ulcerative Colitis |
| Bladder Relaxant Preparations |
May 1, 2006 |
| Lipotropics, Other |
| Lipotropics, Statins |
| PA Required Date - Date physicians/prescribers
and providers are required to request and obtain PA for
non-preferred drugs on the PDL in order for prescription to be
dispensed. This is also the first date drug claims will begin to
deny if approved PA number is not submitted for non-preferred
drugs listed on the PDL. |
| STAT-PA - Dispensing providers may obtain PA for
the non-preferred drugs added to the PDL starting March 17,
2005. For STAT-PA requests, the date of service may be up to 31
days in the future or up to 14 days in the past. |
PDL Phase-In Implementation Schedule (Revised 9/9/05)
PDF (7 KB)
| Therapeutic Class |
Prior Authorization
Required Date |
|
Wisconsin Medicaid and BadgerCare Updates
2005-44 and 2005-60 |
|
Cytokine and CAM Antagonists |
October 1, 2005 |
|
Ace Inhibitors |
|
Alzheimer’s Agents |
|
Antiemetics |
|
Antifungals, Oral |
|
Antifungals, Topical |
|
Antiparkinson’s Agents |
|
Antivirals |
|
Atopic Dermatitis |
|
Bone Resorption Suppression and Related Agents |
|
Bronchodilators, Anticholinergic |
|
Bronchodilators, Beta Agonists |
|
Cephalosporins/Related Antibiotics |
|
Cytokine and CAM Antagonists |
|
Fluoroquinolones |
October 3, 2005 |
|
Glucocorticoids, Inhaled |
|
Hypoglycemics, Insulins |
|
Hypoglycemics, Metformins |
|
Intranasal Rhinitis |
|
Leukotriene Modifiers |
|
Macrolides/Ketolides |
|
NSAIDs |
|
Ophthalmics, Allergic Conjunctivitis |
|
Ophthalmics, Antibiotics |
|
Ophthalmics, Glaucoma Agents |
|
Platelet Aggregation Inhibitors |
|
Sedative Hypnotics |
|
Stimulants and Related Agents |
|
PA Required Date - Date physicians/prescribers
and providers are required to request and obtain PA for
non-preferred drugs on the PDL in order for prescription to be
dispensed. This is also the first date drug claims will begin to
deny if approved PA number is not submitted for non-preferred
drugs listed on the PDL. |
|
STAT-PA - Dispensing providers may obtain PA for
the non-preferred drugs added to the PDL starting September 16,
2005. For STAT-PA requests, the date of service may be up to 31
days in the future or up to 14 days in the past. |
| Therapeutic Class |
Prior Authorization
Required Date |
|
Wisconsin Medicaid and BadgerCare Updates
2005-31 And 2005-32 |
|
Alzheimer’s Agents |
July 1, 2005 |
|
Anticoagulants, Injectables |
July 1, 2005 |
|
Hepatitis C Agents |
July 1, 2005 |
|
Sedative Hypnotics |
July 15, 2005 |
|
Erythropoiesis Stimulating Proteins |
July 29, 2005 |
|
Growth Hormone |
July 29, 2005 |
|
Antiparkinson’s Agents |
August 12, 2005 |
|
Cytokine and CAM Antagonists |
October 1, 2005 |
PDL Phase-In Implementation Schedule (Revised 8/22/05)
PDF (64 KB)
| Therapeutic Class |
Prior Authorization
Required Date |
| Wisconsin
Medicaid and BadgerCare Updates 2005-31 And 2005-32 |
|
Alzheimer’s Agents |
July 1, 2005 |
|
Anticoagulants, Injectables |
July 1, 2005 |
|
Hepatitis C Agents |
July 1, 2005 |
|
Sedative Hypnotics |
July 15, 2005 |
|
Erythropoiesis Stimulating Proteins |
July 29, 2005 |
|
Growth Hormone |
July 29, 2005 |
|
Antiparkinson’s Agents |
August 12, 2005 |
| Cytokine and CAM Antagonists |
October 1, 2005 |
|
PA Required Date - Date physicians/prescribers
and providers are required to request and obtain PA for
non-preferred drugs on the PDL in order for prescription to be
dispensed. This is also the first date drug claims will begin to
deny if approved PA number is not submitted for non-preferred
drugs listed on the PDL. |
|
STAT-PA - Dispensing providers may obtain PA for
the forth group of non-preferred drugs added to the PDL starting
June 16, 2005. For STAT-PA requests, the date of service may be
up to 31 days in the future or up to 14 days in the past. |
| Therapeutic Class |
Prior Authorization
Required Date |
| Wisconsin
Medicaid and BadgerCare Updates 2005-17 And 2005-18 |
|
Lipotropics, Statins - Caduet Only |
Prior Authorization Not Required |
|
Lipotropics, Other -- Antara Only |
April 1, 2005 |
|
Ophthalmics, Glaucoma Agents |
April 1, 2005 |
|
Phosphate Binders |
April 1, 2005 |
|
Antiemetics |
April 15, 2005 |
|
Antihistamines, Nonsedating |
April 15, 2005 |
|
Bronchodilators, Anticholinergic |
April 15, 2005 |
|
Intranasal Rhinitis -- Astelin Only |
April 15, 2005 |
|
Ophthalmics, Antibiotics |
April 15, 2005 |
|
Ophthalmics, Allergic Conjunctivitis |
April 15, 2005 |
|
Ulcerative Colitis |
April 15, 2005 |
|
BPH Treatments |
April 29, 2005 |
|
Antifungals, Topical |
April 29, 2005 |
|
Bladder Relaxants |
April 29, 2005 |
|
Analgesics, Narcotics |
May 13, 2005 |
|
Bronchodilators, Beta Agonists |
May 13, 2005 |
|
Hypoglycemics, Insulins |
May 27, 2005 |
| Therapeutic Class |
Prior Authorization
Required Date |
| Wisconsin
Medicaid and BadgerCare Updates 2004-92 And 2004-93 |
|
ACE Inhibitors/CCB Combinations |
Prior Authorization Not Required |
|
Topical Immunomodulators (Dermatitis) |
Prior Authorization Not Required |
|
Lipotropics, Statins -- Vytorin only |
Prior Authorization Not Required |
|
Beta Blockers |
January 5, 2005 |
|
Calcium Channel Blockers |
January 5, 2005 |
|
NSAIDs -- Prevacid Naprapac only |
January 5, 2005 |
|
Otics, Antibiotics |
January 5, 2005 |
|
Antifungals, Oral |
January 19, 2005 |
|
Antivirals, Influenza |
January 19, 2005 |
|
Antivirals, Other |
January 19, 2005 |
|
Cephalosporins and Related Antibiotics |
January 19, 2005 |
|
Fluoroquinolones |
January 19, 2005 |
|
Macrolides/Ketolides |
January 19, 2005 |
|
Proton Pump Inhibitors (PPIs) |
February 2, 2005 |
| Therapeutic Class |
Prior Authorization
Required Date |
| Wisconsin
Medicaid and BadgerCare Updates 2004-76 And 2004-77 |
|
Leukotriene Modifiers |
Prior Authorization Not Required |
|
Hypoglycemics, Thiazolidinediones |
Prior Authorization Not Required |
|
Angiotensin II Receptor Blockers |
November 1, 2004 |
|
Antimigraine Agents, Triptans |
November 1, 2004 |
|
Bone Resorption Suppression and Related Agents |
November 15, 2004 |
|
Glucocorticoids, Inhaled |
November 15, 2004 |
|
Lipotropics, Statins |
November 15, 2004 |
|
Intranasal Rhinitis Agents |
November 29, 2004 |
|
Lipotropics, Other |
November 29, 2004 |
|
NSAIDs |
December 13, 2004 |
PDL Phase-In Implementation Schedule (Revised 4/1/05)
PDF (60 KB)
|
Therapeutic Class |
Prior Authorization Required Date |
|
Wisconsin Medicaid and BadgerCare Updates
2004-76 and 2004-77 |
|
Leukotriene Modifiers |
Prior Authorization Not Required |
|
Hypoglycemics, Thiazolidinediones |
Prior Authorization Not Required |
|
Angiotensin II Receptor Blockers |
November 1, 2004 |
|
Antimigraine Agents, Triptans |
November 1, 2004 |
|
Bone Resorption Suppression and Related Agents |
November 15, 2004 |
|
Glucocorticoids, Inhaled |
November 15, 2004 |
|
Lipotropics, Statins |
November 15, 2004 |
|
Intranasal Rhinitis Agents |
November 29, 2004 |
|
Lipotropics, Other |
November 29, 2004 |
|
NSAIDs |
December 13, 2004 |
|
Therapeutic Class |
Prior Authorization Required Date |
|
Wisconsin Medicaid and BadgerCare Updates
2004-92 and 2004-93 |
|
ACE Inhibitors/CCB Combinations |
Prior Authorization Not Required |
|
Topical Immunomodulators (Dermatitis) |
Prior Authorization Not Required |
|
Lipotropics, Statins -- Vytorin only |
Prior Authorization Not Required |
|
Beta Blockers |
January 5, 2005 |
|
Calcium Channel Blockers |
January 5, 2005 |
|
NSAIDs -- Prevacid Naprapac only |
January 5, 2005 |
|
Otics, Antibiotics |
January 5, 2005 |
|
Antifungals, Oral |
January 19, 2005 |
|
Antivirals, Influenza |
January 19, 2005 |
|
Antivirals, Other |
January 19, 2005 |
|
Cephalosporins and Related Antibiotics |
January 19, 2005 |
|
Fluoroquinolones |
January 19, 2005 |
|
Macrolides/Ketolides |
January 19, 2005 |
|
Proton Pump Inhibitors (PPIs) |
February 2, 2005 |
|
Therapeutic Class |
Prior Authorization Required Date |
|
Wisconsin Medicaid and BadgerCare Updates
2005-17 and 2005-18 |
|
Lipotropics, Statins - Caduet Only |
Prior Authorization Not Required |
|
Lipotropics, Other -- Antara Only |
April 1, 2005 |
|
Ophthalmics, Glaucoma Agents |
April 1, 2005 |
|
Phosphate Binders |
April 1, 2005 |
|
Antiemetics |
April 15, 2005 |
|
Antihistamines, Nonsedating |
April 15, 2005 |
|
Bronchodilators, Anticholinergic |
April 15, 2005 |
|
Intranasal Rhinitis -- Astelin Only |
April 15, 2005 |
|
Ophthalmics, Antibiotics |
April 15, 2005 |
|
Ophthalmics, Allergic Conjunctivitis |
April 15, 2005 |
|
Ulcerative Colitis |
April 15, 2005 |
|
BPH Treatments |
April 29, 2005 |
|
Antifungals, Topical |
April 29, 2005 |
|
Bladder Relaxants |
April 29, 2005 |
|
Analgesics, Narcotics |
May 13, 2005 |
|
Bronchodilators, Beta Agonists |
May 13, 2005 |
|
Hypoglycemics, Insulins |
May 27, 2005 |
|
PA Required Date — Date physicians/prescribers
and providers are required to request and obtain PA for
non-preferred drugs on the PDL in order for prescription to be
dispensed. This is also the first date drug claims will begin to
deny if the approved PA number is not submitted for
non-preferred drugs listed on the PDL. |
|
STAT-PA — Dispensing providers may obtain PA for
the third group of non-preferred drugs added to the PDL starting
March 17, 2005, except for Nonsedating Antihistamines that may
be obtained starting April 7, 2005. For STAT-PA requests, the
date of service may be up to 31 days in the future or up to 14
days in the past. |
PDL Phase-In Implementation Schedule, (Revised 12/8/04)
PDF (59 KB)
|
Therapeutic Class |
Prior Authorization Required Date |
|
Wisconsin Medicaid and BadgerCare Updates 2004-76
and 2004-77 |
|
Leukotriene Modifiers |
Prior Authorization Not Required |
|
Hypoglycemics, Thiazolidinediones |
Prior Authorization Not Required |
|
Angiotensin II Receptor Blockers |
November 1, 2004 |
|
Antimigraine Agents, Triptans |
November 1, 2004 |
|
Bone Resorption Suppression and Related Agents |
November 15, 2004 |
|
Glucocorticoids, Inhaled |
November 15, 2004 |
|
Lipotropics, Statins |
November 15, 2004 |
|
Intranasal Rhinitis Agents |
November 29, 2004 |
|
Lipotropics, Other |
November 29, 2004 |
|
NSAIDs |
December 13, 2004 |
|
Therapeutic Class |
Prior Authorization Required Date |
|
Wisconsin Medicaid and BadgerCare Updates 2004-92
and 2004-93 |
|
ACE Inhibitors/CCB Combinations |
Prior Authorization Not Required |
|
Topical Immunomodulators (Dermatitis) |
Prior Authorization Not Required |
|
Lipotropics, Statins — Vytorin only |
Prior Authorization Not Required |
|
Beta Blockers |
January 5, 2005 |
|
Calcium Channel Blockers |
January 5, 2005 |
|
NSAIDs — Prevacid Naprapac only |
January 5, 2005 |
|
Otics, Antibiotics |
January 5, 2005 |
|
Antifungals, Oral |
January 19, 2005 |
|
Antivirals, Influenza |
January 19, 2005 |
|
Antivirals, Other |
January 19, 2005 |
|
Cephalosporins and Related Antibiotics |
January 19, 2005 |
|
Fluoroquinolones |
January 19, 2005 |
|
Macrolides/Ketolides |
January 19, 2005 |
|
Proton Pump Inhibitors (PPIs) |
February 2, 2005 |
| PA Required Date — Date physicians/prescribers
and providers are required to request and obtain PA for
non-preferred drugs on the PDL in order for prescription to be
dispensed. This is also the first date drug claims will begin to
deny if approved PA number is not submitted for non-preferred
drugs listed on the PDL. |
| STAT PA — Dispensing providers may
obtain PA for the second group of non-preferred drugs added to the PDL starting December 16, 2004, except for PPIs which may be
obtained starting January 19, 2005. For STAT PA requests, the date
of service may be up to 31 days in the future or up to 14 days in
the past. |
PDL Phase-In Implementation Schedule, (10/1/04)
PDF (43 KB)
| Therapeutic Class |
Prior Authorization Required Date |
|
Leukotriene Modifiers |
Prior Authorization Not Required |
|
Hypoglycemics, Thiazolidinediones |
Prior Authorization Not Required |
|
Angiotensin II Receptor Blockers |
November 1, 2004 |
|
Antimigraine Agents, Triptans |
November 1, 2004 |
|
Bone Resorption Suppression and Related Agents |
November 15, 2004 |
|
Glucocorticoids, Inhaled |
November 15, 2004 |
|
Lipotropics, Statins* |
November 15, 2004 |
|
Intranasal Rhinitis Agents |
November 29, 2004 |
|
Lipotropics, Other |
November 29, 2004 |
|
NSAIDs* |
December 13, 2004 |
| * |
Please note: The following drugs previously required Prior
Authorization (PA).
Effective October 1, 2004 these drugs are non-preferred and
require the use of the new Prior Authorization/Preferred Drug List
(PA/PDL) Exemption Request: Caduet,
Pravachol, Pravigard, Vytorin, Arthrotec, Bextra, Celebrex, Mobic. |
| PA Required Date — Date physicians/prescribers and providers are
required to request and obtain PA for non-preferred drugs on the
PDL in order for prescription to be dispensed. See note above for
exceptions. This is also the first date drug claims will begin to
deny if approved PA number is not submitted for non-preferred
drugs listed on the PDL. |
| STAT-PA — Dispensing providers may obtain PA for non-preferred
drugs listed on PDL starting October 13, 2004. For STAT-PA requests,
the date of service may be up to 31 days in the future or up to four
days in the past. |
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