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Virginia Medicaid Preferred Drug List / Common Core Formulary Changes, 90 Day Supply List Changes, FDA Approval of Over-the-Counter Naloxone, and Drug Utilization Review Board Approved Drug Service Authorizations

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All prescribing Providers, Pharmacists, and Managed Care Organizations Participating in the Virginia Medical Assistance Program
Cheryl J. Roberts, Director Department of Medical Assistance Services (DMAS)

The purpose of this memorandum is to notify providers about updates to the Virginia Medicaid’s fee-for-service (FFS) Preferred Drug List (PDL) Program, 90-day supply list, naloxone FDA approval status, and drug service authorization (SA) requirements for drugs reviewed by the Department’s Pharmacy and Therapeutics Committee (P&T) and the Drug Utilization Review (DUR) Board.

The PDL, or Common Core Formulary (CCF), is a list of preferred drugs, by select therapeutic class, for which the Medicaid fee-for-service program allows payment without requiring an SA.  The PDL program aims to provide clinically effective and safe drugs to its members in a cost-effective manner.  Your continued compliance and support of this program is critical to its success.

The PDL/CCF is effective for the Medicaid, non-dual eligible members enrolled in fee-for-service or managed care programs.  The PDL/CCF does not apply to members enrolled in FAMIS or members with Medicare Part D plans.

Virginia’s PDL/CCF and 90-day list and any updates may be found at under PDL/Common Core Formulary and Documents, respectively. In addition, copies of the PDL and 90-day supply list can be obtained by contacting the Magellan Clinical Call Center at 1-800-932-6648.

Provider Manual updates will be posted about PDL changes.  Comments and questions regarding this program can be emailed to

On March 29, 2023, the FDA approved Narcan, 4 milligram (mg) naloxone hydrochloride nasal spray, manufactured by Emergent BioSolustions, for over-the-counter (OTC) use. Coverage of this OTC product for Virginia Medicaid Fee-for-Service and managed care members is effective as of March 29, 2023. Members will not be charged any copay or out-of-pocket expense. Naloxone is a medication that rapidly reverses the effects of opioid overdose and is the standard treatment for opioid overdose. 

The timeline for availability of this OTC product is unknown. Naloxone products approved for prescription use only will not be interchangeable with the newly designated OTC product. The Department of Medical Assistance Services (DMAS) will be adding this product to the current list of covered OTC products for all enrolled members with pharmacy benefits. In order to bill this product for Virginia Medicaid recipients, pharmacists may utilize the current state standing order ( or the Virginia Board of Pharmacy Pharmacist Statewide Protocol to Lower Out-of-Pocket Expenses (

Questions pertaining to the FDA approval of OTC Narcan may be emailed to

The DUR Board reviewed 3 new medications - Hyftor™, Lytgobi® and Rezlidhia™. The Board also approved therapeutic class service authorization criteria for Oral Oncology – Other Cancer Drugs and approved updates to the therapeutic class service authorization criteria for Oral Oncology – Hematologic Cancers and Other Neoplasm Drugs. Additionally, the Board reviewed the results of several utilization analyses: the impact reports for 3 new DUR medications (Hyftor™, Lytgobi® and Rezlidhia™), the utilization for oral oncology – other cancer drugs, concurrent use of opioids and benzodiazepines, concurrent use of opioids and antipsychotics, antipsychotic medications in children, antidepressant medications in children, mood stabilizer medications in children, ProDUR reports and utilization analysis reports.



Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996

Acentra Health

Service authorization information for fee-for-service members.


Provider Appeals

DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal.

Managed Care Programs

Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE).  In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider.  The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals.

Medallion 4.0

CCC Plus


Magellan Behavioral Health

Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members., email:,or

Call: 1-800-424-4046

Provider Enrollment

In-State: 804-270-5105

Out of State Toll Free: 888-829-5373



Monday–Friday 8:00 a.m.-5:00 p.m.  For provider use only, have Medicaid Provider ID Number available.



Aetna Better Health of Virginia


 1-866-386-7882 (CCC+)

Anthem HealthKeepers Plus


1-833-235-2027 (CCC+)

Molina Complete Care


1-800-424-4524 (CCC+)

1-800-424-4518 (M4)

Optima Family Care


1-844-374-9159 (CCC+)

United Healthcare


1-855-873-3493 (CCC+)

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