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Elizabeth M. Whitehorn, Director

Provider Notice Issued 01/08/2020

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Date:    January 8, 2020

 

To:       All Medical Assistance Program Providers         

 

Re:      Managed Care Organization Grandfathering Clause for Certain Drugs      

 

 

 

This notice provides additional guidance relating to the Department’s managed care organizations’ (MCOs) adoption of the Department’s Preferred Drug List (PDL) beginning January 1, 2020. As part of the MCOs’ transition to the Department’s PDL, patients will be allowed to continue existing drug therapies in specified drug classes, if the current drug is changing to non-preferred status.    

 

By informational notice dated December 19, 2019, providers were advised that beginning January 1, 2020, all MCOs will be required to adopt the Department’s PDL. The MCOs will align their drug coverage with the Department’s so that they and the Department’s fee-for-service program have the same preferred and non-preferred products listed on their PDLs.

 

Participants currently enrolled in an MCO and stabilized on medications in the drug classes found on the attached list will be grandfathered for an initial one-year period. After the initial one-year period, renewals may be granted if the patient is still on the medication and still stable. Each MCO is responsible for devising a strategy to implement this policy.

 

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565, or to the applicable MCO.

 

 

 

Doug Elwell

Medicaid Director

 

 

 

 

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