WellCare’s New York Medicaid

(1)

Page 1 of 2

NY028302_PRO_LTR_ENG Internal Approved 12152014 63821

Dear Provider:

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

Key

UPPER CASE = Brand Name Drugs PA = Prior Authorization Lower case italics = Generic Drugs QL = Quantity Limits PDL = Preferred Drug List ST = Step Therapy YOA = Years of Age AL = Age Limit 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/Reason for 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

UPDATE

WellCare’s New York Medicaid

Preferred Drug List

(2)

Page 2 of 2

NY028302_PRO_LTR_ENG Internal Approved 12152014 63821

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 New York’s Health Plan’s Pharmacy Help Desk is available to assist providers at 1-800-288-5441.

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

Sincerely,

WellCare Health Plans, Inc.