Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Pharmacy

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Pharmacy

Pharmacy

Provider Manuals

General Information for Providers  09/2017

Medicaid manual with general information for all provider types.

Prescription Drug Program 09/27/2017

This manual has information specific to your provider type.

Preferred Drug Information

Preferred Drug List  Rev. 10/25/2017

List of preferred drugs and other preferred drug list information.

Evidence-Based Medicine Documentation

Resources used by the Montana Formulary Committee members come from the OHSU Drug Effectiveness Review Project which can be accessed through this link.

Average Acquisition Cost Links

Provider Notices

Some documents on this page are legal and/or historical in nature and cannot be altered to meet 508 Accessibility standards.  Each of those documents has a corresponding .txt document with the same name placed next to it.

2017

11/20/2017 Qualified Medicare Beneficiary (QMB) Claim Adjustments
11/13/2017 Smart PA® Prior Authorization for Synagis®
11/02/2017 New Medicare Card
10/02/2017 Montana Medicaid Expansion Changes
09/14/2017 Montana Plan First Anesthesia Update
09/14/2017 NCPDP Payer Sheet Update
09/05/2017 Medication Authorization Changes  Rev. 09/21/2017
08/21/2017 Clinical Pharmacist Practitioner
08/14/2017 Medication Authorization Changes
08/01/2017 Telemedicine - Correction
07/03/2017 Clinical Pharmacist Practitioner
05/26/2017 Federal Final Rule, "Nondiscrimination in Health Program and Activities” and Implication for Coverage of Services Related to Gender Transition
05/15/2017  2017 Average Acquisition Cost (AAC) Survey
05/09/2017  2017 Annual Montana Dispensing Fee Survey
04/20/2017  Plan First Hysterectomy codes added effective April 1, 2017
04/11/2017  Medication Authorization Changes
04/06/2017 New EPSDT Request Form
03/31/2017  Ketone Test Strips - A4250 & A252

2016

PDF: 11/30/2016 EnLyte®
TXT:  11/30/2016 EnLyte®
PDF: 11/21/2016 Humira Unit Submission
TXT:  11/21/2016 Humira Unit Submission
PDF: 11/21/2016 PA for Methadone
TXT:  11/21/2016 PA for Methadone
PDF: 11/03/2016 Smart PA® for Synagis® Revised 11/15/2016
TXT:  11/03/2016 Smart PA® for Synagis® Revised 11/15/2016
PDF: 09/26/2016 Coverage of Weighted Blankets
TXT:  09/26/2016 Coverage of Weighted Blankets
PDF: 08/12/2016 Vaccine Administration by Pharmacists
TXT:  08/12/2016 Vaccine Administration by Pharmacists
PDF: 08/12/2016 Removal of 15-day Supply Limit on Initial Atypical Antipsychotic Prescriptions
TXT:  08/12/2016 Removal of 15-day Supply Limit on Initial Atypical Antipsychotic Prescriptions
PDF: 07/28/2016 Montana Plan First Preventive Code Additions
TXT:  07/28/2016 Montana Plan First Preventive Code Additions
PDF: 07/18/2016 Changes to Member Cost Share Update
TXT:  07/18/2016 Changes to Member Cost Share Update
PDF: 06/27/2016 Reverse and Rebill for Drug Cost Disputes
TXT:  06/27/2016 Reverse and Rebill for Drug Cost Disputes
PDF: 06/27/2016 Average Acquisition Cost Reimbursement Methodology
TXT:  06/27/2016 Average Acquisition Cost Reimbursement Methodology
PDF: 05/19/2016 Changes to Member Cost Share
TXT:  05/19/2016 Changes to Member Cost Share
PDF: 04/06/2016 Hepatitis C Prior Authorization Streamlined Request Form
TXT:  04/06/2016 Hepatitis C Prior Authorization Streamlined Request Form
PDF: 03/04/2016 Vaccine Administration by Pharmacists for Adolescents Age 12-18 Years
TXT:  03/04/2016 Vaccine Administration by Pharmacists for Adolescents Age 12-18 Years
PDF: 02/01/2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit
TXT:  02/01/2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit
PDF: 01/15/2016 Standard Medicaid and HELP Plan Claims Processing Rev. 01/19/2016
TXT:  01/15/2016 Standard Medicaid and HELP Plan Claims Processing Rev. 01/19/2016
PDF: 01/15/2016 Hospital Grade Electric Breast Pump Requirements
TXT:  01/15/2016 Hospital Grade Electric Breast Pump Requirements

2015

PDF: 12/31/2015 Changes to Montana Medicaid
TXT:  12/31/2015 Changes to Montana Medicaid
PDF: 12/31/2015 Montana HELP Plan
TXT:  12/31/2015 Montana HELP Plan
PDF: 11/30/2015 New Montana Medicaid Pharmacy Claims Processing System
TXT:  11/30/2015 New Montana Medicaid Pharmacy Claims Processing System
PDF: 11/13/2015 Oral Nutrition for Children Under Age 21 – EPSDT
TXT:  11/13/2015 Oral Nutrition for Children Under Age 21 – EPSDT
PDF: 11/03/2015 Pharmacy Provider License Status
TXT:  11/03/2015 Pharmacy Provider License Status
PDF: 11/03/2015 Services Exempt from Passport to Health Referral
TXT:  11/03/2015 Services Exempt from Passport to Health Referral
PDF: 10/21/2015 SmartPA® Prior Authorization for Synagis®
TXT:  10/21/2015 SmartPA® Prior Authorization for Synagis®
PDF: 10/09/2015 Plan First Prescriptions and ICD-10
TXT:  10/09/2015 Plan First Prescriptions and ICD-10
PDF: 10/09/2015 Montana Plan First – ICD-10 Update
TXT:  10/09/2015 Montana Plan First – ICD-10 Update
PDF: 10/01/2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual
TXT:  10/01/2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual
PDF: 09/25/2015 2015 Annual Montana Dispensing Fee Survey
TXT:  09/25/2015 2015 Annual Montana Dispensing Fee Survey
PDF: 08/03/2015 ICD-10 Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10)
TXT:  08/03/2015 ICD-10 Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10)
PDF: 07/31/2015 Adult and Pediatric Specialty Table of Services Available in Montana
TXT:  07/31/2015 Adult and Pediatric Specialty Table of Services Available in Montana
PDF: 07/08/2015 Montana Plan First – Revised List of Plan First Covered Services
TXT:  07/08/2015 Montana Plan First – Revised List of Plan First Covered Services
PDF: 06/09/2015 National Drug Code (NDC) Billing
TXT:  06/09/2015 National Drug Code (NDC) Billing
PDF: 05/07/2015 Anesthesia and Global Service Requirement
TXT:  05/07/2015 Anesthesia and Global Service Requirement
PDF: 05/06/2015 Prior Authorization Required for Jublia® Topical Solution
TXT:  05/06/2015 Prior Authorization Required for Jublia® Topical Solution
PDF: 03/27/2015 Initial Prescription Fill Requirements for Attention Deficit Hyperactive Disorder Stimulant Drugs
TXT:  03/27/2015 Initial Prescription Fill Requirements for Attention Deficit Hyperactive Disorder Stimulant Drugs
PDF: 02/23/2015 New Restrictions Added to Hydrocodone-Chlorpheniramine Suspension (Tussionex®)
TXT:  02/23/2015 New Restrictions Added to Hydrocodone-Chlorpheniramine Suspension (Tussionex®)
PDF: 02/11/2015 New HCPCS Modifiers – XE, XP, XS, and XU
TXT:  02/11/2015 New HCPCS Modifiers – XE, XP, XS, and XU

Drug Use Review (DUR) Board

Montana Drug Use Review (DUR) Board / Formulary Committee

Notification of upcoming meetings for drug use review, agendas, related meeting information, and minutes from past meetings.

Drug Use Review Board

Information on the Medicaid Drug Use Review Board.

Medicaid Rules and Regulations

MHSP Information

08/31/2015 MHSP Formulary Rev.

08/27/2015 MHSP Preferred Manufacturers 07/2015

Other Resources

To locate older documents, access the Archive Page.