1100 E. William Street, Suite 101 ● Carson City, Nevada 89701
775-684-3676 ● Fax 775-687-3893 ● dhcfp.nv.gov
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Joe Lombardo
Governor
Richard Whitley, MS
Director
DEPARTMENT OF
H
EALTH AND HUMAN SERVICES
DIVISION OF HEALTH CARE FINANCING AND POLICY
Helping people. It’s who we are and what we do.
Stacie Weeks,
JD MPH
Administrator
Nevada Medicaid Pharmacy Preferred Drug List (PDL) Fact Sheet
What is a PDL?
A Preferred Drug List (PDL) is a list of preferred outpatient drugs for Nevada Medicaid. If Nevada Medicaid
places the drug on the PDL, then the State receives additional rebates from the drug manufacturers of
that particular drug, which lowers the total expenditures paid by the State of Nevada for the pharmacy
program.
Who decides which drugs are on the PDL?
The Silver State Scripts Board (SSSB) has been established to replace the Pharmacy & Therapeutics (P &
T) Committee and holds the same responsibilities, which include development of the Preferred Drug
List (PDL). The SSSB consists of members who are Director-appointed physicians and pharmacists.
Members must be licensed to practice in the State of Nevada as either an actively practicing physician or
an actively practicing pharmacist.
There i
s a group of drugs, known as a therapeutic class, which are reviewed by the SSSB to make sure the
drugs are appropriate for comparison to each other and equally effective. Once this is decided the board
then decides based upon their clinical expertise which drugs should be on the PDL.
Are drugs covered if they are listed as non-preferred?
Yes. If the drug is listed as non-preferred it is still available to the recipient.
The recipient’s prescriber can submit a prior authorization request to explain why the preferred
therapeutically equivalent drug on the list is not an appropriate drug for the recipient.
There are certain situations where a non-preferred drug is approved, such as for allergic reactions or the
recipient has already tried the drug on the list, and it was not successful. Reference “PDL Exception
Criteria” policy.
What is the process for getting a drug that is listed as non-preferred?
The recipient’s prescriber would submit a prior authorization to Magellan Rx requesting a non-
preferred drug. The drug would have to meet the “PDL Exception Criteria” policy that is found in
Chapter 1200 of the Medicaid Services Manual. By federal regulation prior authorization for
pharmaceuticals is required to have a response within 24 hours.
For time periods when the prescriber cannot be reached to request prior authorization, (e.g., weekends,
holidays, after hours) or in an emergency situation, the pharmacy can fill a 96-hour emergency supply.
This allows time for the physician to be contacted.
1100 E. William Street, Suite 101 ● Carson City, Nevada 89701
775-684-3676 ● Fax 775-687-3893 ● dhcfp.nv.gov
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The following are examples of what is covered under the PDL Exception Criteria policy. A non-preferred
drug is covered when there is a history of allergies to the preferred drug, the preferred drug does not
interact well with other drugs being taken by the recipient, there is a history of unacceptable side effects,
the recipient’s treatment is not successful on the drugs that are preferred, a diagnosis that only the non-
preferred drug can treat, or for continuity of care for an anti-depressant drug which a recipient was
utilizing in the hospital.
Can all drugs be added within a class on the PDL?
Yes. Even if all drugs are added within the class, the state receives supplemental rebates. This lowers the
overall expenditures paid by the State of Nevada for the pharmacy program. However, to maximize
savings the State needs to see utilization of the preferred drugs.
What happens if the drug class is excluded from the PDL?
If the drug class is completely excluded the State of Nevada cannot participate in the supplemental
program for this class of drugs. Drugs within an excluded class are not subject to non-preferred criteria
but may still require other clinical prior authorization criteria.
What happens with new-to-market drugs released within an existing drug class?
If a new drug is approved within an existing drug class on the PDL, it is considered non-preferred until the
SSSB can review the class. New drugs may not be listed as non-preferred until the class is reviewed.
Does Nevada currently exclude any classes from the PDL?
Yes. NRS 422.4025 does not allow Nevada Medicaid to add the following classes to the PDL.
• HIV/AIDS treatment drug class
• Antirejection drug class
• Antihemophilic drug class
The State cannot receive any additional rebates for these classes due to this statutory exclusion. This also
does not allow the State to receive savings by the shift in market share to a preferred list of drugs.
Do other Medicaid programs have a PDL?
Yes. Most states have a PDL.
Where do I find Nevada Medicaid’s PDL?
The PDL is located under the Preferred Drug List (PDL) section of the web portal (see link below)
https://nevada Medicaid.magellanrx.com/provider/documents
