State Statutory Limits on Medicaid Pharmacy Utilization Controls
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As of July 1, 2019
| Location | State Statutory Limits on FFS Utilization Controls on Any Drug/Drug Class | If Yes, Statutory Limitation Description | Limitation Also Applies to MCOs |
|---|---|---|---|
| United States | Yes: 24, No: 26, NR: 1 | Yes: 14, No: 5, N/A: 6 | |
| Alabama | Yes | HIV drugs are not included on the preferred drug list | N/A |
| Alaska | No | ||
| Arizona | No | ||
| Arkansas | No | ||
| California | No | ||
| Colorado | Yes | Drugs for HIV/AIDS, cancer, epilepsy, and biologically based mental illness are exempt from the generic mandate. | Yes |
| Connecticut | Yes | Limitations on utilization controls for drugs for HIV/AIDS, anticonvulsants, and behavioral health medications. | N/A |
| Delaware | No | ||
| District of Columbia | Yes | MAT drugs cannot be subject to prior authorization | Yes |
| Florida | Yes | Antiretroviral agents are not included on the preferred drug list. The agency will authorize greater maximum supplies for maintenance drugs and provide unlimited contraceptive drugs and items. | Yes |
| Georgia | No | ||
| Hawaii | Yes | Limitations on utilization controls for drugs for psychotropic drugs. | Yes |
| Idaho | No | ||
| Illinois | Yes | Limitations on utilization controls for MAT drugs and seizure medications. | Yes |
| Indiana | Yes | No preference between mental health drugs in the same therapeutic class. | Yes |
| Iowa | No | ||
| Kansas | Yes | Step therapy limitations for MS drugs. If a patient has been on an MS drug for 30 days or more and they are stable, they do not have to change to another drug. | Yes |
| Kentucky | No | ||
| Louisiana | Yes | Antiretrovirals may not be subject to prior authorization. | Yes |
| Maine | No | ||
| Maryland | Yes | HIV/AIDS drugs are not permitted to be on the preferred drug list. They are not subject to preferred drug list prior authorization, but may be subject to quantity limits. | No |
| Massachusetts | No | ||
| Michigan | Yes | Some drug classes exempt from prior authorization, including drugs for HIV/AIDS, cancer, organ replacement therapy and epilepsy. | No |
| Minnesota | No | ||
| Mississippi | No | ||
| Missouri | Yes | May not include antipsychotics on preferred drug list or restrict access to any antipsychotic beneficiares have successfully utilized previously. | N/A |
| Montana | No | ||
| Nebraska | No | ||
| Nevada | Yes | HIV/AIDS and antihemophiliac medications are not included on the preferred drug list. | Yes |
| New Hampshire | No | ||
| New Jersey | No | ||
| New Mexico | No | ||
| New York | No | ||
| North Carolina | Yes | Limitations on utilization controls for hemophilia. | N/A |
| North Dakota | Yes | Limitations on utilization controls for antipsychotics, antidepressants, stimulants for ADHD, anticonvulsants, antineoplastics, antiretrovirals for HIV. | No |
| Ohio | Yes | Psychiatrists exempted from prior authorization of standard dosage forms of oral antipsychotics and can request step therapy exemptions. | Yes |
| Oklahoma | Yes | Limitations on utilization controls for HIV antiretrovirals. | N/A |
| Oregon | Yes | Mental health drugs carved out. | Yes |
| Pennsylvania | No | ||
| Rhode Island | Yes | Limitations on utilization controls for organ transplant drugs and antiretrovirals treating HIV. | No |
| South Carolina | No | ||
| South Dakota | No | ||
| Tennessee | Yes | Limitations on utilization controls for chemotherapeutic agents following nationally recognized guideline exceptions. | Yes |
| Texas | Yes | Non-preferred drug prescriptions for conditions associated with stage-four advanced, metastatic cancer may be prescribed. No preferred drug list prior authorization for certain HIV/AIDS drugs or for MAT drugs. | Yes |
| Utah | NR | ||
| Vermont | Yes | Limitations on utilization controls for HIV/AIDS drugs. | N/A |
| Virginia | Yes | Limitations on utilization controls for atypical anti-psychotics, used for the treatment of serious mental illnesses such as bipolar disorders, schizophrenia, and depression; medications used for the treatment of brain disorders, cancer and HIV-related conditions; and drug classes in which there is only one drug in the class or very low utilization. | No |
| Washington | No | ||
| West Virginia | No | ||
| Wisconsin | No | ||
| Wyoming | No |