Montana Medicaid reimburses only for drugs that are manufactured by companies that have a signed rebate agreement with CMS. An updated list of these manufacturers is available at the on appropriate provider pages. To determine if a manufacturer has signed a rebate agreement, check the first 5 digits of the National Drug Code (NDC) against the list. If there is no match, the drug is not reimbursable.
The list will be updated quarterly, so please check regularly to assure coverage. In addition, the valid NDC must be recorded on the claim (no spaces, no punctuation) as an 11-digit series of numbers. Claims will be denied for drugs billed without a valid 11-digit NDC.
Providers also must be careful when entering the NDC quantity (the administered amount). For more information on billing with NDCs on a CMS-1500, refer to the provider notice dated April 10, 2008.
Introduction to Medicare Part D Drug Benefits
Need help with picking the right Part D plan for you or your member?
State Health Insurance Assistance Program (SHIP) 1.800.551.3191 or visit https://dphhs.mt.gov/SLTC/aging/SHIP.aspx
1.800.MEDICARE (1.800.633.4227) or Medicare.gov
Stand-Alone Prescription Drug Plans Eligible to Receive Auto-Enrolled Beneficiaries in Montana
LiNet run by Humana is the site for facilitated dual beneficiaries. The site helps to eliminate gaps in coverage for low income individuals transitioning to Medicare. See https://www.humana.com/pharmacy/pharmacists/linet
Learn About the Medicare Prescription Drug Plan
The Medicare website for members includes:
• Medicare Prescription Drug Coverage Personal Information Worksheet for People with Medicare and Medicaid
• Choosing a Medicare Drug Plan for People with Medicare and Medicaid
• People with Medicare and Medicaid: Medicare can enroll will be enrolled in a plan automatically. How do you find out which plan?
Request for Prescription Information or Change.
General Prior Authorization forms and forms for specific drug prior authorizations are available on the Forms page.
Medicaid Program Information
Learn more about Medicaid coverage of prescription drugs for members who are dual eligible for both Medicare and Medicaid on page 2.4 of the Prescription Drug Manual.
Visit the Pharmacy provider page (https://medicaidprovider.mt.gov/19) for a list of preferred drugs and upcoming Montana Medicaid and Medicaid Mental Health Drug Use Review Board/Formulary Committee Meetings.
For more information on Montana Prescription Drug Assistance Programs, including help with Medicare Rx premiums, visit Big Sky Rx (https://dphhs.mt.gov/MontanaHealthcarePrograms/BigSky.aspx).