PDL 2025
Effective January 1, 2023, South Dakota Medicaid joined the Sovereign States Drug Consortium. The Preferred drugs listed below are pharmacy benefit drugs unless otherwise noted. If a drug or class is not listed, it is Non-Preferred.
| Therapeutic Category | Preferred Drugs |
| ADHD NON-STIMULANT | NON-STIMULANT ORAL AGENTS (e.g., atomoxetine, clonidine, etc) QELBREE |
| ANTICONVULSANTS | ANTISEIZURE AGENTS (e.g., carbamazepine, lamotrigine, phenytoin, topiramate, etc) DIAZEPAM RECTAL GEL EPIDIOLEX SOLUTION NAYZILAM NASAL SPRAY VALTOCO NASAL SPRAY |
| ANTIDIABETICS GLP-1 RECEPTOR AGONISTS | BYDRUEON BYETTA OZEMPIC RYBELSUS SOLIQUA TANZEUM TRULICITY VICTOZA XULTOPHY |
| ANTIDIABETICS – LONG-ACTING INSULINS | LANTUS LANTUS SOLOSTAR |
| ANTIRETROVIRALS | antiretroviral agents (e.g., abacavir, atazanavir, efavirenz, emtricitabine, lamivudine, nevirapine, ritonavir, tenofovir, zidovudine, & combinations, etc) BIKTARVY DESCOVY GENVOYA ODEFSEY |
| CGM - CONTINUOUS GLUCOSE MONITORING | DEXCOM G6 DEXCOM G7 FREESTYLE LIBRE 14 DAY FREESTYLE LIBRE 2 FREESTYLE LIBRE 3 GUARDIAN 4 GUARDIAN CONNECT GUARDIAN LINK 3 GUARDIAN SENSOR 3 |
| CNS ANTIPSYCHOTICS | ORAL AGENTS (e.g., aripiprazole, clozapine, olanzapine, paliperidone, risperidone, etc) ABILIFY ASIMTUFI ABILIFY MAINTENA ARISTADA ARISTADA INITIO CAPLYTA INVEGA SUSTENNA INVEGA TRINZA INVEGA HAFYERA VRAYLAR |
| CARDIOVASCULAR – ARB-NEPRILYSIN INHIBITOR | ENTRESTO |
| CYTOKINE MODULATORS | ENBREL ENBREL MINI ENBREL SURECLICK HUMIRA HUMIRA Pen HUMIRA Pediatric Crohns-UC-HS HUMIRA Pen Crohns-UC-HS OTEZLA RINVOQ SKYRIZIA SKYRIZI Pen TALTZ |
| DERM-ATOPIC DERMATITIS MONOCLONAL ANTIBODY - ANTI-IL, ANTI IGE | atopic dermatitis topical agents (e.g., pimecrolimus cream, tacrolimus ointment, topical corticosterioid, Eucrisa, etc) DUPIXENT NUCALA XOLAIR |
| EPINEPHRINE INJECTORS | EPIPEN |
| GI PANCREATIC ENZYMES | ZENPEP |
| GLUCOSE TESTING | ACCU-CHEK GUIDE ACCU-CHEK GUIDE ME ACCU-CHEK GUIDE TEST STRIP ACCU-CHEK SOFTCLIX LANCET CONTOUR NEXT EZ CONTOUR NEXT GEN CONTOUR NEXT ONE CONTOUR PLUS BLUE CONTOUR BLOOD GLUCOSE TEST STRIP CONTOUR NEXT BLOOD GLUCOSE TEST STRIP CONTOUR PLUS BLOOD GLUCOSE TEST STRIP |
| GROWTH HORMONES | GENOTROPIN GENOTROPIN MINIQUICK NORDITROPIN FLEXPRO |
| HEMATOPOIETICS – ESA | ARANESP |
| HEPATITIS C | SOFOSBUVIR/VELPATASVIR TAB MAVYRET |
| MIGRAINE - CGRP INHIBITORS | AIMOVIG AJOVY EMGALITY |
| MIGRAINE TREATMENT | TRIPTANS (e.g., almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, etc) UBRELVY |
| MOVEMENT DISORDER | tetrabenazine AUSTEDO AUSTEDO XR INGREZZA |
| OPIOID PARTIAL AGONISTS | buprenorphine buprenorphine-naloxone SUBLOCADE (covered under Medical only) |
| PCSK9 INHIBITOR – CHOLESTEROL LOWERING | REPATHA |
| POTASSIUM REMOVING AGENTS | sodium polystyrene sulfonate (oral) powder, SPS LOKELMA |
| RESPIRATORY - ADRENERGIC COMBINATIONS | COMBIVENT RESPIMAT STIOLTO RESPIMAT |
| UTERINE FIBROIDS AGENT | ORILISSA |