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.

 

Authored By: 
Steven C. Schachter MD
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Authored Date: 
04/2007