Antidepressants — preferred generics and temporary PA waiver
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Temporary change to preferred coverage and prior authorization requirements for specified generic antidepressants for Commonwealth of Kentucky Medicaid Pharmacy Network members, effective immediately through January 5, 2022.
Specified generic antidepressants are preferred without prior authorization.
Coverage Criteria
Preferred generics without PA
Covered without prior authorization during the effective period when dispensed to Commonwealth of Kentucky Medicaid members.
Effective immediately through January 05, 2022
No additional exclusions are specified beyond the listed products and the policy timeframe. The temporary preference applies only to the generics named in the notice and only for the period effective immediately through January 5, 2022.
This notice does not include any statements of not medically necessary items or broader coverage changes beyond the temporary waiver described. Providers should follow usual clinical indications for antidepressant treatment; the administrative change here is limited to prior authorization requirements for the listed generics during the stated effective period.
Coding and Key Dates
| No codes listed |
Provider Actions and Notices
Prior authorization waived for listed generics
Prior authorization is waived for the listed generic antidepressants for the duration of this temporary policy (effective immediately through January 05, 2022). The listed products are preferred without PA during the policy period.
- bupropion XL 150mg and 300mg (generic for Wellbutrin XL)
- venlafaxine ER capsule (generic for Effexor XR capsule)
- desvenlafaxine succinate ER (generic for Pristiq)
- bupropion (generic for Wellbutrin)
- venlafaxine (generic for Effexor)
- desvenlafaxine (generic for Pristiq)
No step therapy or additional requirements specified
During this temporary policy the listed generic antidepressants are preferred and may be dispensed without prior authorization; there are no additional step-therapy requirements specified for these products in this notice.
Documentation and contact information
Providers may dispense the listed generic antidepressants without prior authorization during the policy period. For questions about PBM transition or program details, contact MedImpact's Kentucky Team as listed below.
- Technical Help Desk: 800-210-7628
- Prior Authorizations: 844-336-2676
- Program Questions: KYMCOPBM@MedImpact.com
- BIN: 023800 / PCN: KYPROD1 / GROUP: KYM01
- Policy effective immediately through January 05, 2022
PA waiver applies to listed generics during effective period
The PA waiver applies specifically to the listed generic antidepressants for the duration of this temporary policy; prior authorization requirements do not apply to these products while the policy is effective.
Background
MedImpact issued this temporary coverage change in direct response to supply concerns following recent tornados. To maintain patient access during the disruption, several generic antidepressants were designated as preferred without prior authorization for Commonwealth of Kentucky Medicaid members. This is an administrative, supply-driven adjustment rather than a clinical guideline change and is intended to ensure continuity of therapy while shortages persist.
Definitions
Initial Therapy Criteria
Initial coverage during supply disruption
Temporary initial coverage rule.
Effective immediately through January 05, 2022
Step Therapy
| Step | Requirement |
|---|---|
| 1 | No step therapy requirement stated for the listed generics during the policy period (listed generics are preferred without prior authorization: bupropion XL 150 mg and 300 mg; venlafaxine ER capsule; desvenlafaxine succinate ER; bupropion (generic); venlafaxine (generic); desvenlafaxine (generic)). Policy effective immediately through January 05, 2022. |
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