Drug Information
| Preferred Drug List (PDL) | DATE ADDED |
|---|---|
Kentucky Medicaid PDL Effective 11.1.2025
|
11/01/2025 |
| Prior Authorization (PA) Criteria | DATE ADDED |
|---|---|
|
Prior Authorization (PA) Effective 11.1.2025
|
11/01/2025 |
|
Zepbound PA Criteria - Effective 7.1.2025
|
07/01/2025 |
|
Wegovy PA Criteria - Effective 3.15.2025
|
03/15/2025 |
| Quantity Limits | DATE ADDED |
|---|---|
|
Maximum Quantity Limits - Effective 11.1.2025
|
11/01/2025 |
| Other Drug Information | DATE ADDED |
|---|---|
|
Aduhelm - Prescriber Administered Drug Prior Authorization Criteria
|
04/08/2022 |
|
Diabetic Supplies Preferred Drug List - Effective 7.1.2025
|
06/30/2025 |
|
KY Medicaid Pharmacy Injectable Drug List
|
08/01/2025 |
|
Kentucky Medicaid Vaccine List - FFS & MCO
|
02/11/2025 |
|
Over-the-Counter (OTC) Drug List - FFS Only
|
06/24/2025 |
|
Over-the-Counter (OTC) Drug List - MCO Only
|
06/24/2025 |
|
Zynteglo-Prescriber Administered Drug Prior Authorization Criteria - Effective 7.1.2025
|
06/18/2025 |