MedicaidPrior AuthHigh impact
Pharmacy Program Updates November 2024
Alaska Medicaid·AK · Pharmacy, Pain Management, Psychiatry +4 more·Pharmacy
Effective date
Jan 1, 2025
We identified it
Jun 21, 2026
Summary
Alaska Medicaid is updating their Preferred Drug List (PDL) effective January 1, 2025, and adding new prior authorization requirements for multiple medications including opioids exceeding 150 MME, stimulants for children under 6, and 17 new medications. The policy also requires ICD-10 codes for C-II opioid prescriptions and PDMP checks before prescribing opioids.
Action Required
By January 1, 2025: Billing team must update prior authorization requirements for 21 medications (Kisunla, Tremfya, Winrevair, Zynteglo, Bimzelx, Dupixent, and 15 new-to-market drugs listed). Providers must obtain prior authorization for opioid prescriptions exceeding 150 MME, stimulant medications in children under 6, and multiple stimulant prescriptions. Update billing system to require ICD-10 codes for all C-II opioid prescriptions. Providers must check PDMP before prescribing opioids. Download updated PDL and prior authorization forms from Alaska Medicaid website. Claims without proper prior authorization will be denied.