This page is for pharmacy and health care providers, pharmaceutical company government affairs representatives, and others who have an interest in pharmacy-specific program information of the Connecticut Medical Assistance Program of DSS. Here you will find information and links to pharmacy program information.

The Connecticut Medicaid Preferred Drug Lists (PDL) are a listing of prescription products recommended by the Pharmaceutical and Therapeutics Committee as efficacious, safe, and cost effective choices when prescribing for Medicaid patients. Most FDA approved drugs that are not listed are available, with prior authorization by calling Gainwell Technologies toll-free at 1-866-409-8386.

Drug classes will be added as the Pharmaceutical & Therapeutics Committee review additional classes. The PDLs are not an all-inclusive list of covered Medicaid drugs. Approximately 100 classes of drugs are on the PDL at any time and represent a portion of the total number of classes of drugs available to clients.

HIV medications are excluded from the PDL legislation and will always be preferred drugs and not require a Prior Authorization for PDL.

Current Medicaid Preferred Drug List

Alphabetized Preferred Drug List 

Preferred Drug List Changes 

Previous Preferred Drug Lists

Diabetic Supplies Preferred Product List

Previous Diabetic Supplies Preferred Product List

The purpose of the Medicaid Pharmaceutical & Therapeutics Committee is to develop and implement a voluntary Medicaid preferred prescribed drug designation program, as stipulated in the Connecticut General Statute Chapter 319V, section 17b-274d.
Committee Members
Committee Bylaws
Committee Ethics Statement
Meeting Schedule
Meeting Agenda, Minutes and Recommendations
Meeting Guidelines for Submission or Presentation to Committee

TOP$ Therapeutic Class Review Schedule

Legislation Addressing the Preferred Drug List
Links to Connecticut General Statute Chapter 319V, section 17b-274d. Please refer to the history section of the statute for a listing of amendments.

You can e-mail or call the PDL coordinator, at 1-571-348-0187 with your questions, comments, or concerns.

The Pharmacy Prior Authorization (PA) program is a state-mandated pharmacy initiative. The Pharmacy Prior Authorization program allows DSS to assure appropriate prescribing and utilization of prescribed medications in a cost effective manner. Click on the link below for further information regarding Pharmacy PA.

• State Law Requirements for PA
• Current PA Criteria - Gainwell Technologies
• Brand Medically Necessary
• Cystic Fibrosis
• Early Refill (Over Utilization)
• Opioid Medication (Long and Short Acting)
• Non-Preferred Medication
• Optimal Dosage
• PCSK9i
• Step Therapy
• Current PA Criteria - CHN
• Eteplirsen (Exondys)
• Nusinersen (Spinraza)
• Palivizumab (Synagis)
• Voretigene Neparvovec-rzyl (Luxturna)
• Current PA Criteria - DSS
• Hepatitis C
• Opioid Medication (Long and Short Acting)
• Claim Processing with Prior Authorization
• Request for Back-Dated Prior Authorization
• Prior Authorization Forms
• Prior Authorization forms can be downloaded from the Publications page.
• Optimal Dose List
• Frequently Asked Questions

The Omnibus Budget Reconciliation Act of 1990 (OBRA '90) requires state Medicaid programs to conduct a comprehensive Drug Utilization Review program. This does not include Connecticut Medical Assistance clients with third party insurance. The RetroDUR program collects and analyzes claims data against predetermined, DUR Board approved criteria to identify and correct aberrant prescribing practices, client misuse, and provider fraud. The RetroDUR program also has functionality to identify potential pharmacy restriction candidates and to specify a pharmacy and/or physician provider to assist in correcting client abuse or misuse. The DUR Board is required to implement corrective action to modify practices via appropriate interventions and demonstrate cost savings.

Concurrent with RetroDUR and using the resulting data, the DUR contractor also conducts a pharmacy restriction program. Through RetroDUR, provider, and the medical audit division’s input the contractor identifies certain clients who demonstrate the potential to abuse or misuse of prescription drugs. These clients are offered the opportunity to change their behavior and demonstrate appropriate use of prescription drugs. If the clients continue inappropriate behavior, they are restricted to the use of a single pharmacy for a one-year period per Connecticut State law.

Clients and providers with questions should contact Acentra Health concerning the RetroDUR program operations or pharmacy restriction by calling toll-free to 1-877-719-3123 or by fax to 1-866-743-9788. Further information about the RetroDUR program is available through the following links:

• DUR Board Purpose
• DUR Board Bylaws
• DUR Board Schedule
• DUR Board Agendas
• DUR Board Minutes
• DUR Board Newsletters

• CT Drug Rebate Policies
• Pricing Logic for CT Claims-Pharmacy, UB-04, and CMS-1500
• Non-Qualified SPAP Agreement for Rebate Participation (Husky B)
• SPAP documentation from CMS
• Governor Bill to Maximize Rebates