Attention: Pharmacists and Prescribers N.C. Medicaid and N.C. Health Choice Preferred Drug List Changes

Effective June 5, 2015, the N.C. Division of Medical Assistance (DMA) will make changes to the N.C. Medicaid and N.C. Health Choice (NCHC) Preferred Drug List (PDL) showing preferred and non-preferred oral antipsychotic medications. The use of a non-preferred anti-psychotic medication will require the trial and failure of only one (1) preferred anti-psychotic medication or a prior authorization (PA).

 

ATYPICAL ANTIPSYCHOTICS

Oral

Trial and Failure of only 1 preferred required

Preferred

Non-Preferred

Abilify®

Clozaril®

clozapine (generic for Clozaril®)

Fanapt® Titration Pack

clozapine ODT (generic for FazaClo®)

FazaClo®

Fanapt®

Geodon®

Invega®

olanzapine/fluoxetine (generic for Symbyax®)

Latuda®

Risperdal®

olanzapine (generic for Zyprexa®)

Risperdal M®

olanzapine ODT (generic for Zyprexa® Zydis)

Seroquel®

quetiapine (generic for Seroquel®)

Versacloz®

risperidone (generic for Risperdal®)

Zyprexa®

risperidone ODT (generic for Risperdal M®)

Zyprexa Zydis®

Saphris®

 

Seroquel® XR

 

Symbyax®

 

ziprasidone (generic for Geodon®)

 

Pharmacists: In the event of a prior authorization (PA) requirement, remember to use the 72-hour override (3 in the Level of Service Field) to prevent gaps in therapy.