Pharmacy Provider Representative: Ann Bennett Tel.(401) 784-3840 email [email protected] Please Note: Consumers with questions regarding prescriptions please contact your case manager. Program Information Drug Utilization Review OTC Listing, May 2004 Pharmacy Prior Authorization Program Pharmacy and Therapeutics Committee Preferred Drug List May 6, 2021 Request for Out of State Pharmacy Services General Public Assistance (GPA) Drug Formulary Reference Guide Pharmacy Provider Manual News Internet Drug Outlet Identification Program Progress Report - February 2018 Updates Changes to the RI FFS Medicaid Payer Sheet Effective 2/23/2021 RI FFS Medicaid, in order to support the Comprehensive Addiction and Recovery Act (CARA) of 2016, is adding 2 additional field requirements to the payer sheet for submission of pharmacy claims. The following fields have been added to the payer sheet. These fields will be required on all CII drug Claims. 460-ET Quantity Prescribed Quantity prescribed expressed in metric decimal units384-4X Patient Residence Identifies patient's place of residence The following values will be the only values accepted for Patient Residence for CII drug claims: 1- Home 2- Skilled Nursing Facility 3- Nursing Facility 4- Assisted Living Facility 6- Group Home 11- Hospice 14- Homeless Shelter Any value listed on the payer sheet will be accepted for all non-CII drug claims. Please reference the new payer sheet below and also note this information will be in the March Provider update. RI FFS Medicaid expects to begin receiving these fields on February 23, 2021 Covered Outpatient Drugs Rule Changes to Pharmacy Reimbursement As part of regulatory rules defined by the Covered Outpatient Drugs Rule, EOHHS is implementing changes to the reimbursement algorithm. Medicaid Fee for Service (FFS) pharmacy claims reimbursement algorithm will include the CMS National Average Drug Cost (NADAC) price point and the pharmacy professional fee of $7.90 for recipients residing in a facility and $8.96 residing at home. The EOHHS Drug Assistance Program claims will follow the FFS reimbursement algorithm. These changes will take effect for claims with a date of service equal to or greater than, August 1, 2019. Policy for the Treatment of Hepatitis C Application for Preferred Provider Status for Treating Hepatitis C 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 (January 6, 2021) Do Smoking Cessation Products need a prior authorization? No, effective January 2014 no prior authorization is needed. Tamper Resistant Prescription Pads
