Medicaid Program,

Pharmacy Services

The NH Medicaid Preferred Drug List - PDL (14 pages) is a list of effective prescription drugs within therapeutic drug classes.  These drugs are the recommended first choice when prescribing for Medicaid patients.

NH Medicaid Non-Preferred Drug Approval Fax Forms

• Non-Preferred Drug Approval  (1 page)
• Brand Name Drug Approval  (1 page)
• CNS Stimulant/ADHD Medication Approval  (1 page)  
• Onychomycosis Agents Approval  (1 page) 
• Proton Pump Inhibitor Approval (1 page)
• Receptor Selective NSAID Authorization (1 page) 

QUESTIONS & ANSWERS

1.  What are the advantages of a PDL?

The PDL provides continued access to prescription medications while ensuring that Medicaid pays the lowest cost for medications.  All drugs currently covered will remain available to Medicaid recipients; however, non-preferred drugs will require prior authorization by the prescriber.

2.  How are drugs placed on the PDL?

Drugs within specified therapeutic drug classes will be approved for the PDL based on safety and clinical efficacy first, and then based on cost.

3.  What are the criteria for non-PDL drug approval?  

The prescriber will determine and document that the non-preferred drug is medically necessary. The criteria for approval were recommended by the Pharmacy and Therapeutics Advisory Committee.

4.  Who can I contact for more information?

• If you have additional questions about the PDL program, you may contact Medicaid Client Services at 1-800-852-3345, ext. 4344, or

First Health Client Services at 1-866-664-4506. 

• If you would like to report a concern or problem about the PDL program, you may contact the DHHS Ombudsman at 603-271-6941.

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