MedicaidPrior AuthHigh impact
Preferred Drug List (PDL) and Pharmacy Quarterly Update
Alabama Medicaid·AL · Pharmacy·Pharmacy
Effective date
Oct 1, 2026
We identified it
Sep 19, 2026
Summary
Effective October 1, 2026, Alabama Medicaid is removing DAW Code 9 (brand-only dispensing) from four drugs (Daytrana, Farxiga, Ravicti, Vyvanse capsules) while simultaneously requiring prior authorization for their generic equivalents and four other generics. Brand versions of Arnuity Ellipta, Cipro HC, Incruse Ellipta, and Zylet will retain preferred status with DAW Code 9. The PDL is being updated with quarterly additions and deletions, and pharmacy providers must ensure proper use of OCC and DAW codes to avoid claim recoupments during routine audits.
Action Required
By September 30, 2026: (1) Billing team must update pharmacy billing system to require prior authorization for: generic ciprofloxacin-hydrocortisone, generic fluticasone furoate, generic tobramycin-loteprednol, generic insulin glargine max solostar, generic insulin glargine solostar, and generic umeclidinium ellipta. (2) Remove DAW Code 9 capability for Daytrana, Farxiga, Ravicti, and Vyvanse capsules in the system. (3) Ensure DAW Code 9 remains active for brand Arnuity Ellipta, Cipro HC, Incruse Ellipta, and Zylet. (4) Update PDL in system to add: dapagliflozin (generic Farxiga), lisdexamfetamine dimesylate capsules (generic Vyvanse), and RhapsidoCC. (5) Remove from PDL: generic ciprofloxacin-hydrocortisone, Farxiga brand, Fiasp, generic fluticasone furoate, generic insulin glargine max solostar, generic insulin glargine solostar, generic tobramycin-loteprednol, generic umeclidinium ellipta, and Wegovy. (6) Pharmacy team must maintain supporting documentation for all claims using OCC-3 or DAW-8 codes to prevent recoupments during audits. (7) Notify all prescribers of PA requirements for affected generics. Contact Acentra Health for PA submissions: phone (800) 748-0130 or fax (800) 748-0116. Failure to implement these changes will result in claim denials and potential recoupments.