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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 https://www.virginiamedicaidpharmacyservices.com/provider/ 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 pdlinput@dmas.virginia.gov. 

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 (https://www.vdh.virginia.gov/epidemiology/naloxone/) or the Virginia Board of Pharmacy Pharmacist Statewide Protocol to Lower Out-of-Pocket Expenses (https://www.dhp.virginia.gov/pharmacy/).

Questions pertaining to the FDA approval of OTC Narcan may be emailed to SUD@dmas.virginia.gov

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.