Please see the updates to PDL, Clinical Criteria, and Interim Criteria below and the attached documents for March 2022. These changes went into effect on March 1st.
- Added to preferred: dimethyl fumarate, Dexilant, SPS,
- Added to non-preferred: Tecfidera, Tecfidera starter pack, dexlansoprazole, Dhivy, ciprofloxacin/dexamethasone, Epclusa pellet, Mavyret pellet
- Added to interim: Rezurock, Vuity, Voxzogo,
- BaG additions: Dexilant
- BaG removals: Tecfidera, Tecfidera starter pack
- Hepatic C Direct Acting Antivirals prior authorization criteria and PA forms: removal of restrictions surrounding prior history of substance or alcohol abuse, where applicable, removed questions related to pregnancy, concomitant ribavirin use, and renal function dosage adjustments.
Additionally, these documents can be found on the TennCare website: www.optumrx.com/tenncare
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.