PDL 2023

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
ANTICOAGULANTS - ORAL

WARFARIN TAB
ELIQUIS TAB
ELIQUIS STARTER PACK
XARELTO TAB
XARELTO STARTER PACK

ANTICONVULSANTS

ANTISEIZURE AGENTS (e.g., CARBAMAZEPINE, LAMOTRIGINE, PHENYTOIN, TOPIRAMATE, etc)
DIAZEPAM RECTAL GEL
EPIDIOLEX SOLUTION
NAYZILAM NASAL SPRAY
VALTOCO NASAL SPRAY

ARB-NEPRILYSIN INHIBITOR - CARDIOVASCULAR

ENTRESTO TAB

HEPATITIS C - effective April 1, 2023 SOFOSBUVIR/VELPATASVIR TAB
MAVYRET
PCSK9 INHIBITOR - CHOLESTEROL LOWERING

PRALUENT INJ
REPATHA INJ
REPATHA SURE INJ
REPATHA PUSH INJ

MOVEMENT DISORDER DRUG THERAPY

INGREZZA CAP

RESPIRATORY - ADRENERGIC COMBINATIONS

COMBIVENT RESPIMAT
STIOLTO RESPIMAT

RESPIRATORY - ANTICHOLINERGICS

SPIRIVA RESPIMAT