February 1, 2009

Dear Peach State Provider:

Peach State Health Plan (Peach State) is making some important changes to our Preferred Drug List, and we are writing to communicate the changes to you. Beginning March 1, 2009, the following changes will be made:

1. Member’s medication regimen is restricted one atypical antipsychotic medication at a time. (Members already receiving more than one atypical antipsychotic medication each month will be grandfathered.)

2. Members ages 18 through 64 will be restricted from receiving Seroquel 25mg and 50mg  strengths. (Seroquel dosing for mental health disorders in adults is greater than 200mg per day.)

3. Member’s medication regimen is restricted to one long-acting ADHD stimulant at a time. Long acting stimulants include but are not limited to Adderall XR, Concerta, Metadate CD, Focalin XR, Daytrana, Ritalin SR, Ritalin LA, Vyvanse, and Strattera.

4. Member’s medication regimen is restricted to one Inhaled corticosteroid at a time. Inhaled corticosteroids include Advair, Aerobid, Alvesco, Asmanex, Azmacort, Flovent , Pulmicort, QVAR, Symbicort and, Vanceril.

5. Member’s medication regimen is restricted to one tricyclic antidepressant medication at a time.

6. Member’s medication regimen is restricted to two benzodiazepine medications at a time.

7. Member’s medication regimen is restricted to two antidepressant medications at a time. (There will be an exception for one antidepressant plus trazodone and/or bupropion when used as augmentation therapy.)

8. Member’s medication regimen is restricted to one sedative-hypnotic medication at a time.

9. Member’s medication regimen is restricted to one SSRI/SNRI antidepressant medication at a time.

If you, as a physician, feel that a patient will require medication therapy outside of the above guidelines, you can submit a prior authorization request to Peach State Health Plan. The Medication Prior Authorization Request form is available on the Peach State website, www.pshp.com, under the Provider Forms section. This form can be faxed to US Script at 1-866-399-0929.

 

Thank you

Wendy Bailey, RPh.

Director of Pharmacy

Peach State Health Plan

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