Pharmacy

Medical Coverage Policies

• Pharmacy Coverage Policy 
  • Prescription Requirements
  • Rebate Agreement
  • Brand Necessary
  • Prior Authorization
  • Refillable Medication
  • Maintenance Medication
  • Pharmacy Billing Procedure
  • Limitations Pertinent to Drugs and Pharmacy Services
• Drug Utilization Review (DUR) Program
  • Prospective Drug Utilization Review (DUR)
  • General Requirements
  • Prospective DUR Screen
  • Impact on Pharmacies
  • Patient Counseling
  • Impact on Pharmacies
  • Patient Profiles (Medication Records)
  • Impact on Pharmacies
• Pharmacy Lock-In Program
  • Introduction
  • Legal Basis
  • Enrollment of Recipients
  • Pharmacy Lock-In - REVS
  • Responsibilities of the Primary Pharmacy of Choice
  • Responsibilities of the Primary Care Physician
  • Change in Primary Pharmacy/Physician and Recipient Status
• Pharmacy Pricing Policy
  • Federal Upper Limits for Multiple Source Drugs 
  • DESI Drug List 
  • Over-the-Counter Product List
  • Drug Manufacturers With OBRA 1990 Rebate Agreements 

Recipient Log

• Recipient Log
  • Recipient Prescription Log
  • Prescription Signature Log
  • Certification
  • Pharmacist's Daily Certification

Error Status Codes

• ESC Code List (English) 

Explanation of Benefits (EOB) Codes

• EOB Codes and Messages List (English) 
• EOB Codes and Messages List (Spanish)

Appendix - Third Party Liability Carrier and Coverage Codes

• Third Party Liability Carrier and Coverage Codes

For specific questions you may contact the Customer Service Help Desk at (401) 784-8100 for In-state and long distance callers, or 1-800-964-6211 for In-state toll callers and border communities.