Prior Authorization Criteria
and Step Therapy Guidelines

     It is the goal of the West Virginia Medicaid Drug Utilization Review Board to improve the quality of care for West Virginia Medicaid members through the use of drugs, assuring that the drugs are appropriate, medically necessary, and not likely to result in adverse medical effects.

    Drugs or drug classes which are reviewed and found to be either over utilized, abused or have significant safety concerns are determined to be candidates for prior authorization.  These reviews are considered by the Drug Utilization Review Board and recommendations are made in regard to these drugs or drug classes. 

    West Virginia Medicaid contracts with the West Virginia University School of Pharmacy Rational Drug Therapy Program to provide prior authorization services.  Drugs requiring prior authorization are reviewed by the Board and appropriate criteria for approval are determined by the Board with input from providers, drug manufacturers, and other experts.  Prior authorization reviews will follow the established PA process.  The following agents have established prior authorization criteria, which has been adopted by the Drug Utilization Review Board: 

Review Date: