Pharmacy

Provider Representative:  Ann Bennett  Tel.(571) 895-6866
email   Ann.Bennett2@gainwelltechnologies.com

Please Note: Consumers with questions regarding prescriptions please contact your case manager.

Program Information

• Drug Utilization Review
• OTC Listing  January 2024
• Pharmacy Prior Authorization Program
• Pharmacy and Therapeutics Committee
• Preferred Drug List    October 1, 2024
• Request for Out of State Pharmacy Services
• General Public Assistance (GPA) Drug Formulary

Reference Guide

• Pharmacy Provider Manual

News

Updates:

 At-Home COVID-19 Test Kits

Rhode Island Medicaid Managed Care Organization (MCO) and Fee-for-Service (FFS) beneficiaries were eligible to get up to eight free at-home COVID-19 test kits per month, through September 30, 2024. 

• Policy for the Treatment of Hepatitis C (Updated January 1, 2022)
• RI State Maximum Allowable Cost (MAC) List

Frequently Asked Questions (FAQ's)

• Where can I find the list of J Codes that require an NDC?
• Where can I find information about the RI AIDS Drug Assistance Program (ADAP)?
• Billing Part B Medications
• DUR Alert Override Codes
• Lost or Stolen Prescription Form and Instructions 
• CMS List of Rebateable Drug Manufacturers
• Can pharmacies bill for administering vaccines?
  No.  Billing for administering vaccines is submitted by a medical provider in the Fee-for-Service Medicaid Program.  For more information on vaccines go to: October 2018 Provider Update
• How to bill NDCs on the CMS-1500 Form 
• NCPDP D.0 Payer Sheet (Effective February 23, 2021)
• DESI Drug List (October 2024)

• Do Smoking Cessation Products need a prior authorization?                              No, effective January 2014 no prior authorization is needed.