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July 1, 2005
 
MEDICAID INFORMATION RELEASE 2005-28
 
TO:                 Prescribing Providers, Pharmacists, Pharmacies, Hospitals, and Long-Term Care Facilities
 
FROM:           Randy May, Deputy Administrator
 
SUBJECT:      Replacing information in IR 2004-46 for this drug class only: NEW PREFERRED AGENTS FOR URINARY INCONTINENCE DRUG CLASS 
 
Drug/Drug Class:
URINARY INCONTINENCE
Implementation Date:
Effective for dates of service on or after August 1, 2005
 

Idaho Medicaid is designating new preferred agents for the Urinary Incontinence therapeutic drug class as part of the Enhanced Prior Authorization Program.   Beginning August 1, 2005, the preferred agents for the Urinary Incontinence drug class will be the following:
 
Preferred Agent(s)
Non-preferred Agents^
  • Detrol LA®
  • Enablex®
  • Oxybutynin
  • Oxytrol®
  • Sanctura®
  • Detrol®
  • Ditropan®
  • Ditropan XL®
  • Flavoxate®
  • Vesicare®
^ Use of non-preferred agents must meet prior authorization requirements.
 
The Department requests that providers use the following relative cost ranking table as a secondary factor when determining the most appropriate drug therapy for their patients.
 
Lowest to Highest Relative Cost
(Cost to Medicaid after rebates)
Oxybutynin
100%
Ditropan®
800%
Sanctura®
1120%
Detrol LA®
1440%
Detrol®
1530%
Enablex®
1540%
Oxytrol®
1580%
Vesicare®
1620%
Flavoxate®
1930%
Ditropan XL®
1940%
 
Questions regarding the Prior Authorization program may be referred to Medicaid Pharmacy at (208) 364-1829.

 
A current listing of all the preferred agents by drug class and prior authorization criteria is also available online at www.medicaidpharmacy.idaho.gov.
 
IDAHO MEDICAID PROVIDER HANDBOOK
This Information Release does not replace information in your Idaho Medicaid Handbook.
 
RM/cb