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 to Process at POS for RI FFS Medicaid

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

To get a free at-home COVID-19 test kit, a beneficiary must request a prescription from their enrolled MCO or FFS Medicaid prescriber. The process to prescribe an at-home COVID-19 test kit is the same as the process for other over-the-counter products.

The Rhode Island Executive Office of Health and Human Services (EOHHS) MCO and FFS Medicaid programs allows enrolled Rhode Island pharmacy providers to process at-home COVID test kits at their point of service, such as a pharmacy. Coverage for at-home COVID-19 test kits has not changed with the end of the Public Health Emergency. As with any over-the-counter product, pharmacy and beneficiary coverage of claims for at-home COVID test kits now requires the beneficiary to get a prescription. 

COVID-19 At-Home Test Kits Covered for Dual-Eligible Medicare Medicaid Beneficiaries Living in Skilled Nursing Facilities and Assisted Living Residences

Nursing facilities and assisted living residences may request Medicaid reimbursement for Medicare Medicaid dual-eligible residents for up to eight at-home COVID-19 test kits per month, through September 30, 2024.

Facilities must send reimbursement requests to the Rhode Island Executive Office of Health and Human Services (EOHHS) by November 1, 2024. You can find the reimbursement template and a process overview on the EOHHS website under “Program Information” and “COVID At-Home Test Reimbursement for Duals” at eohhs.ri.gov/providers-partners/provider-directories/nursing-homes.

• 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.