Medicaid Health plans transitioning to Preferred Drug List (PDL)
The Michigan Department of Health and Human Services (MDHHS) has made changes to the list of drugs that all Medicaid Health Plans (MHPs) must cover. This change will impact Medicaid beneficiaries who are enrolled in a MHP, like Priority Health Choice. Effective for dates of service on or after Oct. 1, 2020, MDHHS will require all MHPs to follow the Michigan Preferred Drug List (PDL).
What is the Preferred Drug List (PDL)?
The PDL is a subsection of the Medicaid prescription drug formulary and is already used by Fee For Service (FFS) Medicaid. Drugs included on the PDL are selected by Michigan’s FFS Medicaid program to maximize federal rebates.
The PDL is organized by drug class, with each drug class being further divided into preferred and non-preferred medications. All non-preferred medications will require prior authorization. The Michigan PDL has already been developed and can be viewed online.
How does this change impact Priority Health Choice members?
Prior to Oct. 1, 2020, members who are taking a drug that is non-preferred on the PDL list will need to work with their provider to switch to a covered drug or obtain prior authorization to continue receiving the non-preferred drug. Members who are taking a drug that is preferred on the PDL but requires prior authorization may need to work with their prescriber to obtain a new prior authorization.
We’ll send letters to all impacted members with information about the change and the steps they need to take prior to Oct. 1, 2020.
What action do you need to take?
You’ll need to work with your Priority Health Medicaid program patients who are taking a PDL non-preferred drug, to switch them to a preferred drug or obtain prior authorization to continue the non-preferred drug.
All in-network prescribers with a member impacted by this change will receive a letter outlining the change and steps that need to be taken prior to Oct. 1, 2020.
The PDL will not be fully implemented for MHPs until Oct. 1, 2020. Until then, PDL coverage reflected in the above links only applies to FFS Medicaid. MHPs, including Priority Health’s Medicaid program, will continue to adhere to Medicaid Common Formulary criteria through Sep. 30, 2020