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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.


 
Preferred Drug List 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 Hewlett Packard Enterprise 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


 
Pharmaceutical and Therapeutics Committee
 
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

The Optimal PDL $olutionSM (TOP$SM) Information
TOP$ Therapeutic Class Review Schedule

Legislation Addressing the Preferred Drug List
Links to Connecticut General Statute Chapter 319V, section 17b-274d. This statute was changed during the 2004 May Special Session by Public Act 04-258, Sections 8 and 43; and Public Act 04-2, Sec. 41. This statute was also changed during the 2009 September Special Session by Public Act 09-5, Section 38.

You can e-mail or call the PDL coordinator, at (860) 255-3886 with your questions, comments, or concerns.

 
Pharmacy Prior Authorization Program
 
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.


 
Retrospective Drug Utilization Review Program
 
The Omnibus Budget Reconciliation Act of 1990 (OBRA '90) requires state Medicaid programs to conduct a comprehensive Drug Utilization Review program. Retrospective Drug Utilization Review (RetroDUR) is also being applied to the Connecticut Pharmaceutical Assistance Program for the Elderly and the Disabled (ConnPACE) and Connecticut AIDS Drug Assistance program (CADAP). 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 Health Information Design (HID) concerning the RetroDUR program operations or pharmacy restriction by calling toll-free to 877-719-3123 or by fax to 1-800-881-5573. Further information about the RetroDUR program is available through the following links:

Pharmacy Prior Authorization
Assistance Center
  • toll free at 1-866-409-8386
  • toll free fax at 1-866-759-4110
  • 1-866-604-3470
    (alternate TTY/TDD line)

Serostim - DSS
  • 1-800-233-2503
  • (860) 424-4822 (fax)
Synagis Prior Authorization
  • toll free at 1-866-615-9475
  • (860) 563-1650 (fax)
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