No prior authorization required for non-preferred antidepressants
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Temporary policy removing prior authorization requirements for specified non-preferred antidepressant medications for Commonwealth of Kentucky Medicaid members, in response to tornadoes and supply issues.
No prior authorization is needed for listed non-preferred antidepressant drugs.
Waiver extends through January 05, 2022 for bupropion, venlafaxine, and desvenlafaxine.
Waiver extends through January 31, 2022 for sertraline oral concentrate.
Coverage Criteria
Temporary PA waiver
Covered without prior authorization during the specified temporary periods for the listed drugs.
Effective immediately as of memo date (January 10, 2022).
The memo specifies that only the four listed products are included in the temporary waiver. No prior authorization is required only for bupropion (generic for Wellbutrin), venlafaxine (generic for Effexor), desvenlafaxine (generic for Pristiq), and sertraline oral concentrate (generic for Zoloft oral concentrate). Other antidepressants or formulations are not listed and therefore are not covered by this waiver.
Provider Actions & Operational Notes
Temporary prior authorization waiver for specified non-preferred antidepressants
Prior authorization is waived for the listed non-preferred antidepressant medications for the specified temporary periods: bupropion, venlafaxine, and desvenlafaxine (waiver through January 05, 2022) and sertraline oral concentrate (waiver through January 31, 2022).
- Applies to the listed non-preferred drugs only: bupropion (generic for Wellbutrin); venlafaxine (generic for Effexor); desvenlafaxine (generic for Pristiq); sertraline oral concentrate (generic for Zoloft oral concentrate).
- Effective immediately as of the memo date.
No step therapy changes in this memo
There are no step therapy requirements mentioned or changed in this memo; no new step edits are introduced for these products during the waiver period.
No additional documentation required; contact MedImpact KY Team for questions
The memo does not specify any new documentation requirements or changes. For questions about this administrative change, contact MedImpact's Kentucky Team using the contact information provided in the memo.
- Technical Help Desk: 800-210-7628
- Prior Authorizations: 844-336-2676
- Program Questions: KYMCOPBM@MedImpact.com
Denial risk mitigated during waiver periods
Prior authorization requests for the listed non-preferred antidepressants should not be required during the stated waiver periods; standard denials for lack of prior authorization are not expected for these products during the effective dates.
- Waiver through January 05, 2022 for bupropion, venlafaxine, and desvenlafaxine.
- Waiver through January 31, 2022 for sertraline oral concentrate.
Background
This memo announces a temporary administrative change implemented in response to recent tornadoes and related supply issues to ensure access to medications for Commonwealth of Kentucky Medicaid members. As an immediate measure, prior authorization is waived for the specified non-preferred antidepressants. The waiver is effective immediately from the memo date (January 10, 2022) and continues through January 05, 2022 for bupropion, venlafaxine, and desvenlafaxine, and through January 31, 2022 for sertraline oral concentrate. The memo does not provide clinical guidance on antidepressant selection, dosing, or monitoring.
Definitions
Step Therapy
| Drug | Prior authorization status | Waiver end date |
|---|---|---|
| bupropion (generic for Wellbutrin) | Covered without prior authorization | January 05, 2022 |
| venlafaxine (generic for Effexor) | Covered without prior authorization | January 05, 2022 |
| desvenlafaxine (generic for Pristiq) | Covered without prior authorization | January 05, 2022 |
| sertraline oral concentrate (generic for Zoloft oral concentrate) | Covered without prior authorization | January 31, 2022 |
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