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Drug Information

Information related to covered products and services.

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Preferred Drug List (PDL) DATE ADDED
Link to Kentucky Medicaid PDL Effective 7.5.2025 Kentucky Medicaid PDL Effective 7.5.2025 07/07/2025
Prior Authorization (PA) Criteria DATE ADDED
Download PDF -  Prior Authorization (PA) Effective 7.8.2025 Prior Authorization (PA) Effective 7.8.2025 07/07/2025
Download PDF - Zepbound PA Criteria - Effective 7.1.2025 Zepbound PA Criteria - Effective 7.1.2025 07/01/2025
Download PDF - Wegovy PA Criteria - Effective 3.15.2025 Wegovy PA Criteria - Effective 3.15.2025 03/15/2025
Quantity Limits DATE ADDED
Link to  Maximum Quantity Limits - Effective 7.8.2025 Maximum Quantity Limits - Effective 7.8.2025 07/07/2025
Other Drug Information DATE ADDED
Download PDF - Aduhelm - Prescriber Administered Drug Prior Authorization Criteria Aduhelm - Prescriber Administered Drug Prior Authorization Criteria 04/08/2022
Download PDF - Diabetic Supplies Preferred Drug List - Effective 7.1.2025 Diabetic Supplies Preferred Drug List - Effective 7.1.2025 06/30/2025
Download PDF - Kentucky Medicaid Pharmacy Injectable Drug List Kentucky Medicaid Pharmacy Injectable Drug List 05/02/2025
Download PDF - Kentucky Medicaid Vaccine List - FFS & MCO Kentucky Medicaid Vaccine List - FFS & MCO 02/11/2025
Download PDF - Over-the-Counter (OTC) Drug List - FFS Only Over-the-Counter (OTC) Drug List - FFS Only 06/24/2025
Download PDF - Over-the-Counter (OTC) Drug List - MCO Only Over-the-Counter (OTC) Drug List - MCO Only 06/24/2025
Download PDF - Zynteglo-Prescriber Administered Drug Prior Authorization Criteria - Effective 7.1.2025 Zynteglo-Prescriber Administered Drug Prior Authorization Criteria - Effective 7.1.2025 06/18/2025
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