MedicaidPrior AuthHigh impact
2026.48 - Provider Bulletin - Addition of the HIV/AIDS Class to the Preferred Drug List (PDL)
Connecticut Medicaid (HUSKY Health)·CT · Pharmacy, Infectious Disease, Internal Medicine·Pharmacy
Effective date
Oct 1, 2026
We identified it
Sep 5, 2026
Summary
Connecticut Medicaid is adding the HIV/AIDS drug class to its Preferred Drug List (PDL) effective October 1, 2026. Non-preferred HIV/AIDS medications will require prior authorization (PA). Pharmacies must proactively switch patients to preferred alternatives or obtain PA before dispensing non-preferred products. Brand name preferred products can be dispensed without DAW code '1' unless medically necessary documentation is provided.
Action Required
By September 30, 2026: Billing team and pharmacy staff must (1) Access www.ctdssmap.com to download the complete HIV/AIDS PDL additions and non-preferred drug list; (2) Update billing system to flag HIV/AIDS prescriptions and require PA submission for any non-preferred drugs in this class; (3) Train pharmacy staff on new PA workflow: when a non-preferred HIV/AIDS medication claim is submitted without PA, pharmacy must contact prescriber to either switch to preferred alternative (displayed in NCPDP fields 551-9F and 556-AU) or submit PA via Gainwell Technologies (1-800-842-8440 or Web PA portal at www.ctdssmap.com); (4) Implement 14-day temporary supply override process (NCPDP 462-EV = '999', NCPDP 461-EU = '1') with requirement to provide DSS Temporary Supply Flyer to patients; (5) For brand-name preferred HIV/AIDS medications, configure system to allow DAW codes '5' or '9' without requiring prescriber-documented medical necessity unless DAW '1' is submitted (which triggers audit requirement for 'Brand Medically Necessary' documentation); (6) Coordinate with prescribers to obtain PA in advance using Web PA tool or paper PA forms for known non-preferred HIV/AIDS regimens. Failure to obtain PA will result in pharmacy rejection messages and claim denials. For urgent situations after 14-day override exhaustion, pharmacy can call 24/7 PA Assistance Center at 1-866-409-8386 for one-time 5-day emergency supply.