Preferred Drug List and Coverage Details

​The Preferred Drug List (PDL)  is a medication list recommended to the Bureau for Medical Services by the Medicaid Pharmaceutical and Therapeutics (P & T) Committee and approved by the Secretary of the Department of Health and Human Resources, as authorized by West Virginia Code §9-5-15.  The drugs which are indicated as "preferred" have been selected for their clinical significance and overall efficiencies.

 

All Medicaid-covered drugs noted as "non-preferred" will continue to be available through the prior authorization process.  Some select preferred drugs may require prior authorization, as noted.  A three-day emergency supply of prior-authorized drugs can be dispensed by a pharmacy until authorization is completed.

 

Please note:  The PDL only addresses certain drug classes.  Some classes of drugs will not be reviewed for preferential agents because of no or limited cost savings.  Therefore, drugs which have historically been covered by Medicaid and are not listed on the Preferred Drug List will continue to be covered.

 

New drugs introduced into the marketplace in therapeutic classes that have been reviewed will be considered non-preferred until the annual review of the particular therapeutic class.  Exceptions to this policy will be made for drugs which the FDA has given priority status.

 

BMS contracts with Change HealthCare (CHC),  for assistance with PDL development and clinical support.  BMS is also a member of the Sovereign States Drug Consortium (SSDC), the only state administered multi-state supplemental rebate pool.   For more information about CHC or SSDC, please refer to their websites at www.changehealthcare.com or http://www.rxssdc.org respectively.