What is a Preferred Drug List and Prior Authorization program?
The preferred drug list (PDL) is a list of medications pre-approved by the state for use by Medicaid patients. All drugs that are not on the PDL are classified as “non-preferred” drugs. A physician can only prescribe a non-preferred drug for a Medicaid patient after going through the prior authorization process in which the state reviews the case patient profile and determines whether or not a patient should receive the prescription. Some states’ Pharmaceutical and Therapeutics (P&T) Committees, Prior Authorization (PA) Committees, or Drug Utilization Review (DUR) Committees review classes of drugs and make recommendations on which drugs to include on the PDL. Most states make decisions based on safety, clinical efficacy, and cost. However, some states evaluate a manufacturer’s cost as a primary factor in determining a PDL. How does Prior Authorization work? Healthcare providers must contact a call center to obtain permission to prescribe a drug on the non-preferred list. Only the pres
