Transcription of Preferred Drug List (PDL)
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Preferred Drug List (PDL)
TennCare Preferred Drug List (PDL). Effective January 1, 2022. PA Prior Authorization required, subject to specific PA criteria; QL Quantity Limit (PA & NP agents require a PA before dispensing);. B Budgetary Reduction edit for utilization control (Standard NP PA criteria does not apply); ID Class PA for patients with Intellectual or Developmental Disability Please note the following: All agents must be prescribed by a provider with a Tennessee Medicaid Provider ID. Approval of NP agents requires trial and failure, contraindication, or intolerance of 2 Preferred agents, unless otherwise indicated With the exception of the Branded Drugs Classified as Generics list, TennCare is a mandatory generic program in accordance with state law (TCA 53-10-205). Approval of a branded product when a generic is available requires documentation of a serious adverse reaction from the generic via an FDA MedWatch form OR.
• With the exception of the “Branded Drugs Classified as Generics” list, TennCare is a mandatory generic program in accordanc e with state law (TCA 53 -10-205).
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