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PRO_31759E Internal Approved 03132019

©WellCare 2019 GA9PROLTR31759E_0000 09/12/2019

Dear Provider,

At the 09/12/2019 WellCare Pharmacy & Therapeutics Committee meeting, it was decided that the following changes would be made to the WellCare Health Plans Georgia Families® and PeachCare for Kids®

Medicaid Preferred Drug List (PDL). These changes will be effective 11/26/2019. Please review them carefully.

Key

UPPER CASE = Brand Name Drugs QL = Quantity Limit Lower case italics = Generic Drugs ST = Step Therapy PDL = Preferred Drug List AL = Age Limit PA = Prior Authorization YOA = Years of Age SC = Safety Concerns LU = Low Utilization PC = Pharmacoeconomic Considerations DD = Discontinued Drug GA = Generic Available

Effective date of change: 11/26/2019

Drug Name Therapeutic Class

Change PDL Alternative (if applicable) Permethrin 1% Lotion

*Effective Date 7/30/2019*

Dermatologic Agents

Added to PDL as a Prerequisite for Spinosad Permethrin 5% Cream Dermatologic

Agents

Removed from PDL as a Prerequisite for Spinosad/PC

If you have any questions, please call our Pharmacy Help Desk. The toll-free number is <1-866-231-1821>

Monday-Friday, 7 a.m. to 7 p.m. E.S.T.

Thank you for your care of WellCare Health Plans Georgia Families® and PeachCare for Kids® Medicaid members.

Sincerely,

WellCare Health Plans

UPDATE

WellCare Health Plan Georgia Families® and

PeachCare for Kids® Preferred Drug List

Referencias

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