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MEDICAID INFORMATION RELEASE 2005-05   
TO:     Prescribing Providers, Pharmacists, Pharmacies, Hospitals, and Long-Term Care Facilities
 
FROM: Randy May, Deputy Administrator
 
SUBJECT:       NEW PRIOR AUTHORIZATION CRITERIA FOR ANGIOTENSIN II RECEPTOR ANTAGONISTS AND BETA ADRENERGIC BLOCKER DRUG CLASSES
 
Idaho Medicaid is implementing an Enhanced Prior Authorization Program for select therapeutic classes including the identification of preferred agents. The Enhanced Prior Authorization Program (EPAP) is designed to provide Medicaid participants the most effective drug at the right price.  Beginning March 1, 2005, Angiotensin II Receptor Antagonists and Beta Adrenergic Blocker agents will be the next drug classes to have new prior authorization requirements:
 
 
Drug/Drug Class:
 
ANGIOTENSIN II RECEPTOR ANTAGONISTS AND BETA ADRENERGIC BLOCKERS
Implementation Date:
Effective for dates of service on or after March 1, 2005
 
Drug Class
Preferred Agent(s)
Non-preferred Agent(s)^
·         Angiotensin II Receptor Blockers
·         Avapro®
·         Cozaar®
·         Micardis®
·         Atacand®
·         Benicar®
·         Diovan®
·         Teveten®
·         Beta Blockers
·         Atenolol
·         Acebutolol
·         Betaxolol
·         Bisoprolol
·         Labetalol
·         Metoprolol tartrate
·         Nadolol
·         Pindolol
·         Propranolol
·         Innopran XL®
·         Timolol
·         Toprol XL®
·         Coreg® (Heart Failure ONLY)
·         Blocadren®
·         Cartrol®
·         Corgard®
·         Inderal®
·         Inderal LA®
·         Kerlone®
·         Levatol®
·         Lopressor®
·         Normodyne®
·         Sectral®
·         Tenormin®
·         Trandate®
·         Visken®
·         Zebeta®
^ Use of non-preferred agents must meet prior authorization requirements
 
To assist our providers with providing the right care at the right time with the right price, the Department is presenting the relative cost ranking of the preferred agents net of all rebates in these classes.  The Department requests that all Medicaid providers consider this ranking as a secondary factor when determining the most appropriate drug therapy for their patients.
 
 
Lowest to Highest Relative Cost
(Cost to Medicaid after rebates)
Angiotensin II Receptor Blockers
Micardis®
100%
Avapro®
140%
Cozar®
150%
Beta Blockers
Metoprolol Tartrate
100%
Atenolol
110%
Propranolol HCL
210%
Acebutolol
590%
Labetalol HCL
730%
Timlolo, Toprol XL®
740%
Innopran XL®
750%
Bisoprolol
1,000%
Nadolol
1,040%
Betaxolol
1,080%
Pindolol
1,460%
Coreg®
2,540%
Point-of-service pharmacy claims will be routed through an automated computer system to apply PA criteria specifically designed to assure effective drug utilization.  Through this process, therapy will automatically and transparently be approved for those patients who meet the system approval criteria.  For those patients who do not meet the system approval criteria, it will be necessary for you to contact the Medicaid Drug Prior Authorization help desk at (208) 364-1829 or fax a PA request form to (208) 364-1864 to initiate a review and potentially authorize claims.  To assist in managing patients affected by these changes, Medicaid will be sending in a separate mailing a list to prescribing providers of their patients who are currently receiving therapy and whose claims for these drugs will be affected.
 
The Enhanced PA Program and drug class specific PA criteria are based on evidence-based clinical criteria and available nationally recognized peer-reviewed information.  The determination of medications to be considered preferred within a drug class is based primarily on objective evaluations of their relative safety, effectiveness, and clinical outcomes in comparison with other therapeutically interchangeable alternative drugs and secondarily on cost. 
 
Additional therapeutic drug classes will be added in the coming months to the Enhanced Prior Authorization (EPAP) program.  Please watch for further information releases on the Medicaid Pharmacy website at www.healthandwelfare.idaho.gov .
 
A current listing of all the preferred agents by drug class and prior authorization criteria is also available online at www.healthandwelfare.idaho.gov.
 
As always, your support is critical to the success of this Medicaid Pharmacy initiative. It is our goal to partner with you in the provision of quality, cost-effective health care to your patients.  Questions regarding the Prior Authorization program may be referred to Medicaid Pharmacy at (208) 364-1829.
 
IDAHO MEDICAID PROVIDER HANDBOOK:
This Information Release does not replace information in your Idaho Medicaid Provider Handbook.
 
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