Prior Authorization

ANNOUNCEMENTS

Medications that are new to the market which fall into a class of drugs currently on the PDL will be automatically placed on prior authorization until the class is reviewed by the PDL Advisory Committee. (10/6/06)

ATTENTION PHARMACY PROVIDERS
Wyoming Medicaid is implementing an Enhanced Prior Authorization Program (SmartPA) with the goal of reducing the administrative burden associated with prescribing drugs which require prior authorization. SmartPA uses a clinical rules system to determine if evidence-based criteria for appropriate drug use are met. The application executes real-time prior authorization (“PA”) decisions within the pharmacy POS process through clinical rules fueled by Wyoming-specific drug and medical claims data.

Therapy will automatically and transparently be approved for those patients who meet the system approval criteria. For those patients who do not meet the system approval criteria, it is necessary for the prescriber to contact the Prior Authorization Help Desk at (866) 556-9320 or fax a PA request form to (307) 777-8623 to initiate a review and potentially authorize claims. The Second Request for Patient Exemption from Prior Authorization Criteria is available below. With the new Smart PA program, this is the only paper form that will be required.

If you have any questions, please contact the Office of Pharmacy Services at 1-800-438-5785.

In addition to those designated as non-preferred in the classes currently included on the Preferred Drug List the following medications require prior authorization for coverage through Wyoming Medicaid:

Xolair
Zofran
Angiotensin II Receptor Blockers
Xopenex MDI and Solution

Prior Authorization Frequently Asked Questions
Brand Name Drug Request Form (updated 8/2/07)
Second Request for Patient Exemption from Prior Authorization Criteria (updated 8/2/07)

Prior Authorization ANNOUNCEMENTS

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Prior Authorization

ANNOUNCEMENTS