Attention prescribers and pharmacies January 1, 2013 PDL and prior authorization criteria updates Key changes effective Jan. 1, 2013
The Division of Medical Assistance Programs (DMAP) has made the following updates: Prior authorization (PA) criteria updates for two drug classes Physical health drugs now preferred (listed below) Physical health drugs now non-preferred that require PA (listed below)
PA criteria updates New criteria for IV/SQ Pulmonary Arterial Hypertension (PAH) Agents Updated criteria for Erythropoiesis Stimulating Agents (ESAs) Specific criteria can be found in the DMAP Fee-for-Service PA Criteria Guide on the Pharmaceutical Services Clinical Information page at OHP Preferred Drug List updates Physical Health PDL changes
The following drugs are now preferred on the Physical Health PDL: Inhaled hypertonic saline solution within the Cystic Fibrosis drug class Dornase alfa within the Cystic Fibrosis drug class with quantity limitations of 30 vials per 30 days Omnitrope® within the Growth Hormone drug class Canasa® suppository and balsalazide within the Ulcerative Colitis drug class Ciloxan® ointment within the Ophthalmic Antibiotics drug class Sevelamer and calcium acetate within the Phosphate Binders drug class Risedronate within the Bone Metabolism Agents drug class Alvesco® as an ICS alternative in the Asthma Controllers drug class Advair® in the ICS/LABA Combination Agents drug class Detemir in the Insulins drug class Antara®, Tricor® and gemfibrozil in the Other Lipotropics drug class Natroba® in the Topical Antiparasitics drug class Focalin XR® and Focalin® IR in the ADHD drug class
The following drugs are now non-preferred on the Physical Health PDL and now require PA: Alendronate with vitamin D3 within the Bone Metabolism Agents drug class Nutropin® and Genotropin® within the Growth Hormone drug class Mesalamine rectal enemas and kits within the Ulcerative Colitis drug class Pegasys® in the Hepatitis C drug class Asmanex® as an ICS alternative in the Asthma Controllers drug class Proventil® in the Asthma Rescue drug class Insulin glargine in the Insulins drug class All fibric acid derivatives other than Antara®, Tricor® and gemfibrozil in the Other Lipotropics drug
Ciprofloxacin/dexamethasone in the Otic Antibiotics drug class Pramlintide in the Amylin Analogs drug class Zenpep® in the Digestive Enzymes drug class Epoetin alfa in the Hematopoietic Agents drug class Tadalafil in the PAH drug class Concerta®, Ritalin LA® and their generic equivalents in the ADHD drug class
Voluntary Mental Health PDL changes Make olanzapine preferred and make risperidone rapid dissolving tabs non-preferred How to request PA
For non-preferred physical health products, you can submit PA requests three ways:
1. Call the Oregon Pharmacy Call Center at 1-888-202-2126; 2. Submit via the secure Provider Web Portal a 3. Fax a completed Pharmacy and Oral Nutritional Supplement Request (DMAP 3978) to 888-346-0178.
This form is available on the DHS|OHAWeb site a
To view the PDL: Use the free Epocrates drug guide to access the PDL on your mobile device or desktop Internet browser
(look for "Oregon Medicaid - Open Card"). For more information, g
Refer to the Pharmaceutical Services administrative rulebook at
(see Table 121-0030-1 Practitioner-Managed Prescription Drug Plan).
You will also find links to these resources on the PDL Web page a
We can help
We understand that your patients will have questions and concerns. Please share our Client Services toll-free number with OHP patients: 1-800-273-0557. Representatives are available Monday through Friday, 8:00 a.m. to 4:45 p.m.
Questions? About this announcement or the Provider Web Portal: Call the Provider Services Unit at
1-800-336-6016, Monday through Thursday from 8:30 a.m. to 4:30 p.m. and 10 a.m. to 4:30 p.m. on Friday.
About pharmacy point of sale and prior authorizations: Call the Oregon Pharmacy Call Center at
About physical health prescriptions for health plan (CCO or FCHP) clients: Contact the client's plan. DMAP CAPE 12-197 12/12
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MATERIAL SAFETY DATA SHEET CALCIUM HYDROXIDE immediate medical (ophthalmologic) attention. 1 PRODUCT AND COMPANY IDENTIFICATION Speed in treatment can prevent serious eye damage. Clumps of moist material may lodge CALCIUM HYDROXIDE deeply in cul-de-sacs inferiorly and superiorly, and may be difficult to remove by normal irrigation. Ensure adequate flushing by opening eyelids
Attention prescribers and pharmacies 
Ciprofloxacin/dexamethasone in the Otic Antibiotics drug class Pramlintide in the Amylin Analogs drug class Zenpep® in the Digestive Enzymes drug class Epoetin alfa in the Hematopoietic Agents drug class Tadalafil in the PAH drug class Concerta®, Ritalin LA® and their generic equivalents in the ADHD drug class
Voluntary Mental Health PDL changes