Please see the updates to the PDL, Clinical Criteria, and Interim Criteria below for April 2022. These changes went into effect on April 1st.
- BaG additions: Combigan
- Added to preferred: naloxone, Valtoco, glycopyrrolate solution, Myfembree
- Added to non-preferred: Dartisla ODT, Eprontia, Xarelto suspension, Xenleta, Brexafemme, nitazoxanide, Elepsia XR, Azstarys, adapalene/benzoyl peroxide, carglumic acid, Zokinvy, Palforzia, Lumakras, Tepmetko, Qinlock, bimonidine/timolol, Bronchitol
- Added to interim: Recorlev, Tarpeyo, Livmarli, Trudhesa, Tyrvaya, Skytrofa, Besremi, Tavneos, Adbry, Livtencity
- Modified criteria/quantity limits for Adderall, Adderall XR, Adefovir, Adhansia XR, Adzenys ER solution, Adzenys XR ODT, amphetamine ER suspension, Ancobon, Arikayce, Baraclude solution, clonidine ER, Cotempla XR ODT, Cresemba, Daytrana, Desoxyn, Dexedrine spansule, dexmethylphenidate XR, dextroamphetamine soln, Dificid tablet and suspension, doxycycline hyclate 20mg, Dyanavel XR, Evekeo tab & ODT, flucytosine tablets, Focalin, Fuzeon, Hepsera, Intuniv, Isentress HD, itraconazole, Jornay PM, ketoconazole, linezolid suspension, Lumakras, methamphetamine, Methylin solution, methylphenidate chewable, methylphenidate ER, methylphenidate SA OSM, methylphenidate XR ODT, Mycobutin, Mydayis ER, Nuzyra, Oravig, Pegasys syringes, Pegasys vials, Qelbree, Qinlock, Quillichew ER, Quillivant XR, Relexxii, Ritalin, Ritalin LA, Sporanox, terbinafine tablets, Tybost, Vemlidy, Xenleta, Zenzedi, Zyvox suspension, Zyvox tablets.
Additionally, these documents can be found on the TennCare website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.