• Medicaid Providers
• Change Healthcare

This measure is important because it monitors how often providers are prescribing a preferred medication versus a non-preferred medication requiring a Prior Authorization (PA). This allows DVHA to target and educate low compliance prescribers to improve compliance rates and lower DVHA’s net costs.  

This measure shows the percentage of Medicaid prescriptions that have a preferred status on DVHA’s Preferred Drug List (PDL).  The Preferred Drug List is one of the most effective tools available to DVHA to assure clinically appropriate and cost-effective prescribing. The PDL is designed to manage the state’s cost of providing prescription drugs while assuring broad access to clinically appropriate and cost-effective therapy. Both clinical and cost considerations determine PDL placement.

The trendline for CY2022 Q2 showed a decrease from 97.0% to 95.8% and again in CY2022 Q3 from 95.8% to 95.1%. This is a result of some non-preferred prescribing which is expected due to various clinical considerations of the patient. For example, some patients may have tried and failed on a preferred therapy, so their provider is trying an alternate product. The purpose of the PA process is to document these unique clinical considerations. Sometimes requests for non-preferred drugs come from specialist because members may have tried and failed the preferred formulation. 

Narrative last updated:  04/12/23

The Pharmacy Unit receives a detailed claims report of providers who have the lowest PDL compliance. A goal in CY2023 is to continue reviewing this report periodically for any opportunities for educational outreach to providers with lower compliance rates.