Starting July 1, all managed care organizations that offer drug benefits for Minnesota Health Care Programs – such as Medical Assistance and MinnesotaCare – will be required to use a Uniform Preferred Drug List (PDL), created and managed by the Minnesota Department of Human Services (DHS).
The MMA was a strong advocate for this change because it’s designed to:
• Reduce disruptions in therapy when a patient moves from one plan to another
• Create uniformity across all managed care organizations
• Make it easier for providers to identify when a patient’s drug is on their plan’s PDL.
The PDL will apply only to pharmacy claims in which a drug is billed and dispensed in a pharmacy. It does not apply to provider-administered drugs that are billed as a medical claim – this will continue to be carried out by each managed care organization according to their coverage policy and clinical criteria.
Each managed care organization will continue to maintain a formulary that is more comprehensive than the PDL. While patients will have access to all drugs on the PDL, they will also have access to other drugs on their plan’s formulary. However, drugs not on the PDL may require prior authorization. Managed care organizations will also continue to use the same clinical criteria and coverage policies for drugs that are not on the PDL.
If a patient has received prior authorization for a drug before July 1, it will be honored until the prescription expires. If a patient is being treated with a drug that was previously on their plan’s PDL – but is not on DHS’ Uniform PDL – the prescriber can request a 90-day continuation of therapy. After 90 days, the prescriber must request a prior authorization or switch the patient to an alternative therapy.
Providers that treat patients in managed care organizations should receive specific information from the managed care organization on these changes and how they will affect patients in that plan.
The PDL can be found here
. For more information on the changes, click here
. If you have further questions, contact the DHS provider call center at 651-431-2700.