This notice is being sent to notify you of changes for the TennCare pharmacy program. We encourage you to read this notice thoroughly and contact Magellan’s Pharmacy Support Center (866-434-5520) should you have additional questions. PREFERRED DRUG LIST (PDL) FOR TENNCARE EFFECTIVE 10-1-16 TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL may occur as new classes are reviewed and previously reviewed classes are revisited. As a result of these changes, some medications your patients are now taking may be considered non-preferred agents in the future. Please inform your patients who are on these medications that switching to preferred products will decrease delays in receiving their medications. A copy of the new PDL will be posted October 1, 2016 to https://tenncare.magellanhealth.com. We encourage you to share this information with other TennCare providers. The individual changes to the PDL are listed below. For more details on clinical criteria, please visit: https://tenncare.magellanhealth.com

Effective September 1, 2016, Blue Cross and Blue Shield of Kansas City (Blue KC) will update its prescription drug list (PDL), which will result in select medications moving from Tier 1 to Tier 2 and others from Tier 2 to Tier 3. When multiple tiers are present within a drug class, generally members must try a lower tier medication before a higher tier can be dispensed. In addition, quantity limits to various medications will be applied. The list of quantity limits is available at BlueKC.com (click "Contact", then click "FAQs" and scroll to "Medications with Quantity Limits"). The tables below contain detailed information regarding these changes. If you have questions, please call Pharmacy Customer Service at 816.395.2176 or 800.228.1436 and ask for the Clinical Unit.

Effective March 1, 2016, Blue Cross and Blue Shield of Kansas City’s Blue KC plan will update its Commercial prescription drug list (PDL), which will result in some medications moving from Tier 2 to Tier 3. These medications will reject with 75 (Prior Authorization Required) beginning March 1. Members will be required to try a lower cost medication that is proven safe and effective for treating their condition and/or symptoms. If an alternative medication doesn’t work (e.g., a member’s symptoms persist, unwanted side effects occur, or an allergy develops, etc.), a prior authorization may be requested to allow the Tier 3 drug (step therapy).

The Alabama Medicaid Agency is making changes to payment for atovaquone oral suspension, and has updated its preferred drug list.