| DATE: |
|
November 1, 2004 |
| TO: |
|
Blood Banks, Dentists, Dispensing Physicians, Federally
Qualified Health Centers, Nurse Practitioners, Pharmacies,
Physician Assistants, Physician Clinics, Physicians,
Podiatrists, Rural Health Clinics, HMOs and Other Managed Care
Programs |
| FROM: |
|
Wisconsin Medicaid |
| SUBJECT: |
|
Revision of approval criterion for certain brand
medically necessary drugs |
Effective immediately, the Department of Health and Family Services
is revising one approval criterion for certain brand medically
necessary (BMN) narrow therapeutic index (NTI) drugs.
The NTI drugs are:
- Coumadin.
- Dilantin.
- Neoral.
- Tegretol.
Clinical criteria for prescribing BMN drugs must be documented by
the prescriber on the
MedWatch form
(PDF, 54 KB).
Effective immediately, criteria for approval of a prior authorization
(PA) request for these brand name NTI drugs are now:
- An adverse reaction to the generic drug(s).
- An allergic reaction to the generic drug(s).
- Actual or anticipated therapeutic failure of the generic drug(s).
The revised criterion now includes anticipated therapeutic failure
of the generic drug(s) in addition to the actual failure of the generic
drug(s), as previously noted. To address the revision to this
criterion, prescribers should consider the following: For recipients
already stabilized on a brand name NTI drug, is there an actual or anticipated therapeutic failure of the generic drug?
Documentation on the MedWatch form must indicate how the brand name
drug will prevent recurrence of an adverse or allergic reaction or
therapeutic failure of the generic drug. Documentation should include
the prescriber’s concern that switching this recipient to a generic
product is likely to have an adverse reaction. The PA request may be
approved if the prescriber documents an anticipated therapeutic failure
with a switch to a generic drug.
For additional information on the BMN drug policy, refer to the
August 2004 Wisconsin Medicaid and BadgerCare Update (2004-63), titled
"Prescriber Information on Prior Authorization Requirements for Brand
Medically Necessary Drugs (PDF, 318 KB)."
Providers may also call Provider Services at (800) 947-9627 or (608)
221-9883 for information regarding coverage of Wisconsin Medicaid,
BadgerCare, and SeniorCare drugs.
Wisconsin.gov |
