Medicaid AED Rules for Generic Substitutions by State

Medicaid's rules concerning generic substitutions for anticonvulsant medications (AEDs) are presented in this chart. Where indicated, a state has a Preferred Drug List (PDL) that includes AEDs. Where known, any AEDs that are not on the PDL for a state are listed. Some AEDs require Prior Approval (PA) before Medicaid will cover their use. Approval must be requested by the prescribing physician. Please read the "Unique Medicaid Features" column carefully for your state. Any questions should be directed to those authorities.

PDL = Preferred Drug List.
* Drugs omitted from a state PDL may still be covered; Consult with agency to determine coverage.
† Some listed agents on a PDL may still require prior authorization for approval.
‡ Medications listed by generic name unless alternative dosage form is not covered.
AED = Anticonvulsant drug.
PA = Prior Authorization required.
MCO = managed care organization.
NA = no preferred drug list mentioned in state Medicaid documents.
Unknown= preferred drug list mentioned in state Medicaid documents, but contents were not available.

The information presented in this chart is for reference only. Prescribers, please consult the State Medicaid Office in your state for specific requirements and wording to be sure that medications are dispensed as you have determined appropriate for your patient. Any questions should be directed to those authorities.

State Medicaid Program Attributes
State	PDL*	AEDs on PDL†	AEDs Not on PDL‡	Unique Medicaid Features
Alabama	√			AL has a limit on brand name medications to 4/month. Limit is waived for individuals < 21 years old and nursing home residents.
Alaska	√	√	Acetazolamide, Lorazepam, Clonazepam, Phenobarbital
Arizona	N/A			Medicaid Prescription Drug Benefits are managed by an MCO, with individual MCOs controlling which drugs are covered.
Arkansas	√			Anticonvulsant medication not limited by a PDL.
California	√	√	Pregabalin, Felbamate
Colorado	N/A
Connecticut	√			AEDs not limited by a PDL. PA's required for brand name drugs if ≥ 3 generic equivalents exist.
Delaware	√	√	Lorazepam	If AED has a generic, then that generic is preferred. Brand name medication may require a PA or may not be covered.
Florida	√	√	Tiagabine; Felbamate; Tegretol XR	4 brand name drugs allowed per month. If AED has a generic, then that generic is on the PDL - not the brand name medication.
Georgia	√	√	Primidone, Tiagabine, Ethosuximide, Gabapentin, Valproic acid, Carbatrol	Generic medications are considered preferred medications; Check with agency to determine if omitted generic medications are covered.
Hawaii	√	Unknown	Unknown
Idaho	√	√	Lorazepam	If AED has a generic, then that generic is preferred - not the brand name medication. Exception is Dilantin. PA may be required for Brand Name agents.
Illinois	√	√	Lorazepam, Clonazepam	If AED has a generic, then that generic is on the PDL, not the brand name medication.
Indiana	N/A			Medicaid Prescription Drug Benefits are managed by an MCO, with individual MCOs controlling which drugs are covered.
Iowa	√	√
Kansas	√	√	Unknown	Only 5 non-preferred medications allowed per month. KS has a small listing of AEDs, which excludes many agents. Exact excluded agents are unknown.
Kentucky	√	√	Unknown	KY has a limit on brand name medications to 4/month. Waived for individual < 19 years old and nursing home residents. Can be overridden for those with a diagnosis of epilepsy. KY has a small listing of AEDs, which excluded all brand agents. Exact excluded agents are unknown.
Louisiana	√			Unknown if LA covers classes of drugs not on PDL. AEDs are excluded from PDL.
Maine	√	√	Depakote ER	PA required for ≥ 6 brand name medications.
Maryland	√	√	Lorazepam	Generics are preferred. Brands require PA.
Massachusetts	√	√		Generics are preferred. Brands require PA unless brand does not have an equivalent generic.
Michigan	√		Carbatrol	AEDs are not on PDL but are covered.
Minnesota	Unknown	Unknown	Unknown
Mississippi	√	√
Missouri	N/A
Montana	√			Unknown if MT covers classes of drugs not on PDL. AEDs are excluded from PDL.
Nebraska	√	√
Nevada	√			NV covers agents not currently on PDL, such as AEDs.
New Hampshire	√			NH covers agents not currently on PDL, such as AEDs.
New Jersey	Unknown	Unknown
New Mexico	√	√	Tiagabine, Pregabalin, Felbamate, Leviteracetam, Equetro	Generic medications are mandatory when a brand name is prescribed.
New York	√			NY cover agents not currently on PDL, such as AED. Brand names require PA, with exception of Tegretol, Dilantin, Zarontin.
North Carolina	N/A
North Dakota	N/A
Ohio	√			OH covers agents not currently on PDL, such as AEDs.. Brand names require PA.
Oklahoma	√	√	Equetro	Some brand names are non-preferred and require PA.
Oregon	√	√	Ethosuximide, Oxcarbazepine, Phenobarbital, Primidone, Zonisamide
Pennsylvania	√	√	Lorazepam
Rhode Island	√			Unknown if RI covers classes of drugs not on PDL. AEDs are excluded from PDL.
South Carolina	√			SC covers 4 prescriptions per month and is not overridden for those with epilepsy. Unknown if SC covers classes of drugs not on PDL, but it is suspected; AEDs are excluded from PDL, yet brand name phenytion and carbamazepine are excluded from PA requirements.
South Dakota	N/A			Some medications require PA; however, AEDs are not included.
Tennessee	√			Unknown if TN covers classes of drugs not on PDL. AEDs are excluded from PDL.
Texas	√			Unknown if TX covers classes of drugs not on PDL. AEDs are excluded from PDL.
Utah	Unknown	Unknown		≥ 7 prescriptions per month triggers a review of the Medicaid recipient drug usage.
Vermont	√			Unknown if VT covers classes of drugs not on PDL. AEDs are excluded from PDL.
Virginia	√			VA covers FDA-approved drugs not on PDL. AEDs are excluded from PDL.
Washington	√			If a drug is non-preferred, PA may be warranted. AEDs are excluded from PDL.
West Virginia	√	√	Lorazepam
Wisconsin	√	√	Lorazepam
Wyoming	√			WY covers agents not on the PDL, such as AEDs. PA is required for name brand agents, with the exception of Dilantin, Depakene, Mysoline, Tegretol.

Submitted on: 04/25/07
Reviewed by: Steven C. Schachter, MD