Transcription of Kentucky Medicaid Pharmacy Preferred Drug List
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Kentucky Medicaid Pharmacy Preferred Drug List
2021 Magellan Health, Inc. All rights reserved. Magellan Medicaid Administration, part of the Magellan Rx Management division of Magellan Health, Inc. Kentucky Medicaid Pharmacy Program Single Preferred drug List (PDL) Effective: December 14, 2021 GENERAL DEFINITION OF TERMS Clinical Criteria (CC) Due to the nature of some medications, prior authorization (PA) is required for the medication to be covered. Medications with this indicator may require prior use of a different medication or drug product, a qualifying diagnosis to be reported and/or appropriate clinical criteria to be satisfied before prior authorization is approved.
perindopril Prinivil® Qbrelis ... amlodipine/benazepril valsartan/amlodipine valsartan/amlodipine/HCTZ ... Tracleer® 32 mg tablets for suspension CC
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