Medicaid.state.ar.us

Arkansas Medicaid Evidence-Based
Prescription Drug Program
501-526-4200 · Fax: 501-526-4188 · WATS 866-250-2518
November 12, 2008
Subject: Evidenced-Based review of Non-insulin anti-diabetic agents, including oral sulfonylureas,
non-sulfonylurea secretagogues, Thiazolidinediones (“TZD”), and Newer Drugs for the Treatment
of Diabetes Mellitus.

Effective January 1, 2009, Glimepiride, Glipizide, Glyburide, Glyburide micronized, Starlix® (nateglinide),
Prandin® (repaglinide), Actos® (pioglitazone), Actosplus Met® (poiglitazone/metformin), Duetact®
(pioglitazone/glimepiride), Avandia® (rosiglitazone), Avandamet® (rosiglitazone/metformin), Avandaryl®
(rosiglitazone/glimepiride) will be the preferred drugs in the Non-insulin anti-diabetic agents and will be
reimbursed by Arkansas Medicaid without prior authorization. Metformin was not included in the evidence-based
review. Generic metformin, generic metformin combination products (glipizide/metformin and glyburide/metformin),
and the preferred metformin combination products listed above, are covered products and available without prior
authorization.
Effective January 13, 2009, Symlin® injection (pramlintide), Janumet® (sitagliptin/metformin), Januvia®
(sitagliptin), and Byetta® injection (exenatide) will move to non-preferred status in the non-insulin anti-diabetic
agents.
Non-preferred agents in the non-insulin anti-diabetic drug classes will reject at point of sale. If the prescriber
believes that a non-preferred product is medically necessary and the patient does not meet applicable edits, the
prescriber must contact the UAMS Prior Authorization (PA) Call Center (see phone number above) to speak directly
with clinical pharmacists and, if requested, to a physician concerning the request for a non-preferred drug. After a
PA request is approved and entered into the system, the pharmacy can fill the prescription and submit the claim.
PA requests for non-preferred drugs will be approved for up to six months.

As described in the Official Notice dated December 8, 2004, Arkansas Medicaid has established an Evidence-
Based Prescription Drug List. Medications selected for the Evidence-Based Prescription Drug List represent one of
two situations. The medication may offer a clear, proven clinical advantage over other similar medicines. If all
medications in a drug class are found to be equally safe and effective, the preferred drug represents the most
economical choice to provide effective treatment for the greatest number of patients. Arkansas Medicaid preferred
drug(s) are selected after review of all publicly available clinical evidence by a committee of Arkansas clinicians,
including physicians and pharmacists. The Drug Review Committee’s recommendations are passed to a second
committee which considers utilization and net-net cost (cost inclusive of available manufacturer rebates) for the
Arkansas Medicaid system. Your use of Arkansas Medicaid-preferred drugs will provide your patients with
medications proven to be the best available for their medical conditions and help to ensure continuation of services
and reimbursement levels in the Arkansas Medicaid Program.
This advance notice is to provide you the opportunity to contact, counsel and change patients on less proven or
less cost-effective medicines to the Arkansas Medicaid-preferred drug. If you are an Arkansas Medicaid provider
and have prescriptions attributed to you by your provider ID number by the dispensing pharmacy, we are attaching
a list of those patients who have been identified as receiving prescriptions for drugs that are not on the preferred
drug list in the referenced class. If you are not currently prescribing the referenced drug(s) or are not prescribing
drugs in the referenced class(es), this provider notice is being submitted to you for informational purposes only.
www.medicaid.state.ar.us
Serving more than one million Arkansans each year
PDL Evidence-based Re-review non-insulin anti-diabetic agents As a reminder, Medicare-Medicaid beneficiaries (duals) are not eligible for Medicaid prescription drug benefits for
these medications after January 1, 2006.
Note: You are reminded that protected health information (PHI) may not be disclosed. Therefore you are
advised to redact all PHI belonging to other individuals from this list prior to placing this list in a patient
file.

Preferred drugs will be added to the list on the Arkansas Medicaid website as they are determined.
If you need this material in an alternative format, such as large print, please contact our Americans with Disabilities
Act Coordinator at (501) 682-6789 or 1-877-708-8191. Both telephone numbers are voice and TDD.
Arkansas Medicaid provider manuals (including update transmittals), official notices and remittance advice (RA)
messages are available for downloading from the Arkansas Medicaid website: .

Source: https://www.medicaid.state.ar.us/Download/provider/pharm/pdlDiabetes20110808.pdf