Dear Peach State Provider:

Peach State Health Plan (Peach State) sent a letter to you on March 1, 2010 to let you know about some important changes to our Preferred Drug List. The changes went into effect on April 1, 2010. The changes that were made are described below:

1. Patients will only be allowed to receive one long acting stimulant and two short acting stimulants per month without prior authorization.

We are sending this addendum to the March 1st letter to provide more information about the prescribing of Intuniv. Intuniv is not on the Peach State Preferred Drug List and must be obtained through prior authorization. If approval is granted for Intuniv, it can not be filled in combination with any other long-acting stimulant medication without prior authorization for the dual therapy.

If you have a member who is currently receiving Intuniv in combination with any other long-acting stimulant medication, please consider using either Intuniv or the long-acting stimulant as monotherapy.

If you believe that your patient will require medication therapy outside of the above guidelines, you may submit a prior authorization request to US Script, the pharmacy benefit manager for 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 D. Bailey                                               Robyn A. Lorys, Pharm. D.
Director of Pharmacy                                    Director of Clinical Pharmacy
Peach State Health Plan                                Peach State Health Plan

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