Prescribed Drugs Provider Manual - Iowa Department of Human ...

IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage15DateAugust 1, 2013b. Exceptions to the Nonpreferred Default Policy for New PDL DrugsThere are two major potential exceptions to the nonpreferred defaultpolicy for new PDL drugs:♦ If the FDA classifies a new medication as a priority drug, the statemay indicate that such a drug is preferred until the P&T Committeereviews the drug at its next scheduled meeting.♦ The state may decide to designate a new drug as “draft preferred”and provide immediate access and increased therapeutic choice tophysicians until the P&T Committee reviews the drug at its nextscheduled meeting if:• A new drug is therapeutically equivalent or superior to existingpreferred or nonpreferred choices, and• Is as safe or safer than existing preferred or nonpreferredchoices, and• The net cost, adjusted for all rebates, is less expensive than allexisting preferred choices.c. Existing PDL Drugs With Supplemental RebatesAlthough the state discourages supplemental rebate offers on existingPDL drugs between annual bidding periods, it may entertain such bidsand may accept them if they:♦ Are determined to represent significant additional savings, or♦ Would replace a delinquent manufacturer’s product or a preferreddrug pulled from the marketplace or significantly restricted by theFDA.This interim preferred status will remain in effect until the P&TCommittee reviews the drug at its next scheduled meeting.Supplemental rebates will be invoiced only for approved drugs undercontract. Draft preferred drugs with supplemental rebates will not beinvoiced until approved by the Committee and accepted by the state. Atthat time, the supplemental rebates will be invoiced back to the effectivedate of the agreement, which is the date the drug began to benefit frompreferred status.