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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, 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 June 8, 2023 The DUR Board reviewed 5 new medications - Jaypirca™, Joenja®, Krazati™, Orserdu™ and Tezspire® Pen. The Board also approved therapeutic class service authorization criteria for Oral Oncology – Breast Cancer and Other Neoplasm Drugs and approved updates to the therapeutic class service authorization criteria for Oral Oncology – Other Cancer Drugs and Oral Oncology – Lung Cancer and Other Neoplasm Drugs. Additionally, the Board reviewed the results of several utilization analyses: the impact reports for 5 new DUR medications (Jaypirca™, Joenja®, Krazati™, Orserdu™ and Tezspire® Pen); the utilization for oral oncology – breast cancer and other neoplasm drugs; compounding of Hyftor™; concurrent use of opioids and benzodiazepines; concurrent use of opioids and antipsychotics; overlaps in opioids, benzodiazepines and antipsychotics; anticholinergic load; ProDUR reports, RetroDUR reports and utilization analysis reports.

On September 14, 2023 The DUR Board reviewed information and Service Authorization (SA) criteria for 5 new medications - Cuvrior™ (trientine tetrahydrochloride), Daybue™ (trofinetide), Furoscix® (furosemide injection), Skyclarys™ (omaveloxolone), and Veozah™ (fezolinetant). Annually, the Board reviews the Synagis criteria at the September meeting prior to the Respiratory Syncytial Virus (RSV) season beginning October 1, 2023 through March 31, 2024. Additionally, the Board reviewed the results of ProDUR and RetroDUR reports, several utilization analyses: antipsychotic medications in children, antidepressant medications in children, mood stabilizer medications in children, and Overlaps in Antipsychotics, Antidepressants and Mood Stabilizers in Children.