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MEDICAID INFORMATION RELEASE 2005-25

posted on March 02, 2009 12:18

July 1, 2005

MEDICAID INFORMATION RELEASE 2005-25

TO: Prescribing Providers, Pharmacists, Pharmacies, Hospitals, and Long-Term Care Facilities

FROM: Randy May, Deputy Administrator

SUBJECT: PRIOR AUTHORIZATION CRITERIA FOR INHALED BETA-2 AGONIST DRUG CLASS

Drug/Drug Class:	INHALED BETA-2 AGONISTS
Implementation Date:	Effective for dates of service on or after August 1, 2005

Idaho Medicaid is designating preferred agents for the Inhaled Beta-2 Agonist therapeutic drug class as part of the Enhanced Prior Authorization Program. Beginning August 1, 2005, the preferred agents for the Inhaled Beta-2 Agonist drug class will be the following:

Preferred Agent(s)	Non-preferred Agents^
Albuterol Formoterol (Foradil^®) Salmetrol (Serevent^®) Serevent^® Diskus	Acceneb^® Alupent^® Maxair^® Autohaler Metaproterenol Sulfate Xopenex^®

^ 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)
Short Acting Agents
Albuterol	100%
Alupent^®	330%
Maxair^® Autohaler	410%
Metaproterenol Sulfate	510%
Accuneb^®	900%
Xopenex^®soln	970%
Long Acting Agents
Serevent^®	1040%
Serevent^® Diskus	1130%
Foradil^®	1150%

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. Thank you for your continued participation in the Idaho Medicaid program.

IDAHO MEDICAID PROVIDER HANDBOOK

This Information Release does not replace information in your Idaho Medicaid Provider Handbook.

RM/cb

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