Preferred Drug List

(1)

KY028299_PRO_LTR_ENG Internal Approved 12082014 63815

Dear Provider:

At the October 24, 2018 WellCare Pharmacy & Therapeutics Committee meeting, it was decided that the following changes will be made to the WellCare’s Kentucky Medicaid Preferred Drug List (PDL), effective 01/01/2019. Please carefully review these changes.

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: 01/01/2019

Drug Name Therapeutic Class Change PDL Alternative (if applicable) ADDITIONS TO THE PDL

AMITIZA 8 mcg & 24

mcg capsule Gastrointestinal agents-misc

Added to the PDL w/ PA

UTILIZATION MANAGEMENT CHANGES REMOVALS FROM THE PDL ASMANEX metered

dose twisthaler- all strengths

Antiasthmatic and Bronchodilator agents

Removed from the PDL (LU)

ARNUITY ELLIPTA 50 mcg/act, 100 mcg/act & 200 mcg/act powder for inhalation,

QVAR REDIHALER 40 mcg/act & 80 mcg/act aerosol

ASMANEX HFA 100 mcg/act inhalation aerosol

QVAR REDIHALER

UPDATE

WellCare of Kentucky Medicaid

Preferred Drug List

(2)

KY028299_PRO_LTR_ENG Internal Approved 12082014 63815

40 mcg/act & 80 mcg/act aerosol

FLOVENT DISKUS 50 mcg/act 100 mcg/act/ &

250 mcg/act powder for inhalation

FLOVENT HFA 44 mcg/act, 110 mcg/act &

220 mcg/act inhalation aerosol

Removed from the PDL (PC)

QVAR 40 mcg/act & 80 mcg/act inhalation aerosol

SPIRIVA RESPIMAT 1.25 mcg/act & 2.5 mcg/act inhalation solution

Removed from the PDL (PC)

INCRUSE ELLIPTA 62.5 mcg/act powder for inhalation

If you have questions, WellCare of Kentucky’s Pharmacy Help Desk is available to assist providers at 1-877-389-9457.

Thank you for your care of WellCare’s Kentucky Medicaid members.

Sincerely,

WellCare Health Plans, Inc.