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Prior Authorization Program for Second Generation Antihistamines
The planned implementation date of the second generation antihistamines prior authorization program has
been delayed to May 5, 2008.
On May 5, 2008, the N.C. Medicaid pharmacy program will require prior authorization on second generation antihistamines. Medications that will require prior authorization include Clarinex, Allegra, fexofenadine, Xyzal and Zyrtec (prescription versions only). Over-the-counter (OTC) versions of loratadine, Claritin, cetirizine and Zyrtec will not require prior authorization.
Prescribers can request prior authorization through ACS by contacting ACS at 866-246-8505 (telephone) or 866-246-8507 (fax). If a prescriber has not requested prior authorization through ACS, a pharmacist can override the PA requirement at point-of-sale if the prescriber writes one of the following phrases on the face of the prescription:
- For generic fexofenadine
- “Failed loratadine and failed cetirizine for 30 days”
- “Allergy to loratadine and cetirizine”
- For liquid formulations other than loratadine and cetirizine syrup
- “Failed loratadine and failed cetirizine syrup for 30 days”
- “Allergy to loratadine and cetirizine syrup”
- For all other second generation antihistamines
- “Failed loratadine for 30 days, failed cetirizine for 30 days and failed fexofenadine for 30 days”
- “Allergy to fexofenadine, loratadine, and cetirizine”
If a second generation antihistamine medication has a generic version available, “medically necessary” must also be written on the face of the prescription in order to dispense the brand name drug.
The criteria and PA request form for these medications will be available on the N.C. Medicaid Enhanced Pharmacy Program website.
Updated April 16, 2008