Medicaid issued the following updates:
- Dulera is experiencing manufacturing delays. Due to sporadic backorders expected through October:
- The PA requirement for Advair Diskus and Advair HFA will be delayed at this time. Members may continue or switch to Advair Diskus or Advair HFA if Dulera is unavailable.
- The Dulera 200 mcg/5 mcg quantity limit allows one inhaler to be billed as a 60 days supply.
- Asmanex HFA will be allowed concurrently with Dulera 50 mcg/5 mcg. You will need to contact us to request an override for this option.
- Effective October 1: Dulera will be the only ICS/LABA inhaler that does not require PA.
- Advair HFA and Advair Diskus will be non-preferred status and require PA.
- All other ICS/LABA inhalers remain non-preferred status and require PA.
- Please work with prescribers to transition patients now to avoid treatment disruption.
Dulera contains formoterol and can be used for single-inhaler maintenance-and-reliever therapy (SMART) as recommended in asthma guidelines. ND Medicaid allows up to two Dulera inhalers per 30-day supply for SMART use.
- Effective October 1: Steqeyma no longer requires PA.
- Selarsdi and Yesintek remain Step 1 non-preferred status and require PA.
- Stelara and other ustekinumab biosimilars remain Step 2 non-preferred status and require PA.
- Effective October 1: Ozempic and Rybelsus will be preferred status and will not require PA.
- Victoza (brand) and liraglutide labeler 00480 remain preferred status and do not require PA.
- Liraglutide labelers 00143 and 71288 will be non-preferred status and require PA.
- Trulicity remains non-preferred status and requires PA.
- Effective October 1: Clonidine patches will require PA for members 10 years and older.
- Electronic age verification occurs during adjudication at the point of sale.
- See Non-Solid Dosage Forms criteria.
- Effective October 1: The manufacturer of Xifaxan and Trulance will cease participation in the Medicaid Drug Rebate Program (MDRP).
- Xifaxan and Trulance will no longer be eligible for coverage by ND Medicaid.
ND Medicaid cannot pay for a drug when the manufacturer does not participate in the MDRP due to federal law, Sec.1927. [42. U.S.C. 1396r-8] (a).
- Manufacturers choose whether they will sign up for the MDRP.
- Manufacturer participation is outside of ND Medicaid's control.
An alternative, participating manufacturer's product or different drug that is covered must be used for Medicaid to be able to pay.
For more information, contact LeNeika Roehrich, PharmD, BCGP.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
