Pharmacy
General Information for Providers
Medicaid manual with general information for all provider types.
Prescription Drug Program
This manual has information specific to your provider type.
Code of Federal Regulations (Title 42)
Montana Code Annotated - https://leg.mt.gov/ (Choose “Laws & Bills” then “ Montana Statutes – MCA”)
Applicable Section: Title 53, Chapter 6
Preferred Drug List 11/20/2024
List of preferred drugs and other preferred drug list information.
*Nursing facilities are responsible for providing OTC antacids, aspirin, and laxatives to their residents.
- Antacids*
- Antihistamine ophthalmic solutions (as listed on PDL)
- Antiviral, topical medications (as listed on PDL)
- Aspirin*
- Diphenhydramine
- Doxylamine
- Folic acid
- H2 antagonist GI products
- Head lice treatment (as listed on PDL)
- Insulin (as listed on PDL)
- Laxatives*
- Levonorgestrel
- Nonsedating antihistamines (as listed on PDL)
- Nicotine patches, gum and lozenges
- NSAID, topical (as listed on PDL)
- Opioid reversal agents (as listed on PDL)
- Proton pump inhibitors (as listed on PDL)
- Steroid nasal spray (as listed on PDL)
2024
12/19/2024 IRS Tax Identification Letter Required for Pay-To Providers
11/04/2024 Paper Claim Denials
10/30/2024 Beyfortus and Synagis Coverage for RSV Prophylaxis
10/18/2024 Electronic Adjustments Void or Void/Replace
10/15/2024 Revalidation Requirements Deadline
10/11/2024 COVID-19 Vaccine Codes Removed from Plan First Covered Codes List
10/09/2024 Pharmacy Provider License Renewal Reminder
10/03/2024 NABP Enrollment Requirements
09/25/2024 Plan First COVID Vaccine Coverage Changes
09/04/2024 Covid At-Home Tests and Vaccine Coverage Changes
07/01/2024 2024 Annual Pharmacy Dispensing Fee Survey
06/28/2024 January 1, 2024 and July 1, 2024 Fee Schedule Updates
06/18/2024 DEA Number Required for Prescribers REVISED
05/21/2024 DEA Number Required for Prescribers
05/01/2024 Paperwork Attachments Submission Timing for Electronic Claims
05/01/2024 Eligibility Inquiry and Service Type Code in the MATH Portal
04/19/2024 Changes Regarding Opioid Prior Authorization and Medication for Opioid Use Disorder
03/27/2024 HHS Letter to Healthcare Providers
03/27/2024 Resources for Providers in Response to the Change Healthcare Cyberattack
03/27/2024 Updated CLIA Claims Editing
03/27/2024 Avoiding Claim Denials
03/27/2024 Location Address and Provider Maintenance Updates
03/19/2024 Electronic Funds Transfer Payment Verification
03/12/2024 Valid Member ID and Eligibility Verification
03/12/2024 Provider Initiated Claims Adjustment
03/05/2024 Voiding Claims With a Prior Authorization
01/23/2024 Montana Healthcare Programs Support Services Holiday Closure REVISED
01/17/2024 Prior Authorization Criteria for Atypical Antipsychotics for Children 8 Years of Age and Under REVISED
01/08/2024 AMP Cap Removal and Medication Access
01/08/2024 Electronic Claim Adjustment Processing Change
2023
12/22/2023 Passport Provider Referral Number on Claims
12/12/2023 Individual Providers Enrolled as Sole Proprietors Due for Revalidation
11/07/2023 Pharmacy Provider License Renewal Reminder
11/01/2023 Beyfortus and Synagis Coverage for RSV Prophylaxis
10/31/2023 Managed Care Referrals IHS, Tribal 638, and Urban Indian Organizations REVISED
09/15/2023 Claims Payment Discrepancy Update
09/14/2023 Claims Payment Discrepancy Identified
09/08/2023 Medicaid Claims Payment Delayed
08/01/2023 Provider License Expiration Reminder Letters
07/06/2023 Provider Rate Increases
06/30/2023 2023 Annual Montana Dispensing Fee Survey
05/26/2023 Medicaid Reimbursement and Court Ordered Services REVISED
05/03/2023 End of PHE Pharmacy Signature Requirements
05/03/2023 Makena PV Makena (Hydroxyprogesterone Caproate Injection) Coverage
04/10/2023 Resumption of Face-to-Face Requirements for Selected Programs REVISED
03/22/2023 Coverage and Reimbursement Policy for Telemedicine/Telehealth Services
03/22/2023 End of Public Health Emergency (PHE) Effects on Pharmacy Coverage
03/22/2023 Non-Covered Services Agreement Policy Return to Requirements
03/22/2023 Reinstatement of the Primary Care Provider Referral for Passport
03/22/2023 Resumption of Face-to-Face Requirements for Selected Programs
03/22/2023 Resumption of Prior Authorization Requirements Revised 04/03/2023
03/17/2023 End of Temporary Revision to Case Management General Provisions
03/10/2023 Provider Meetings for Medicaid Eligibility Redetermination and Unwinding PHE Flexibilities
03/09/2023 Add-on and E&M Code Editing
03/03/2023 End of Public Health Emergency
01/31/2023 Omnipod Coverage
01/04/2023 Montana Healthcare Programs Support Services Holiday Closures
2022
12/23/2022 Plan First Updated Code List Descriptions
11/15/2022 Pharmacy Provider License Renewal Reminder
11/09/2022 Prior Authorization Criteria for Synagis®
09/19/2022 New Plan First Covered Code
08/05/2022 Bipartisan Budget Act of 2018 Cost Avoidance Statute Changes
07/08/2022 2022 Annual Montana Dispensing Fee Survey
06/17/2022 Plan First Updated Code List Descriptions
05/31/2022 2022 Average Acquisition Cost (AAC) Survey
05/27/2022 Albuterol HFA Inhalers - Preferred Drug List Enforcement
05/16/2022 Help Members Receive Important Information from Montana Medicaid and Stay Covered
05/13/2022 Revalidation Extended REVISED
05/13/2022 National Drug Code (NDC) Denial Errors
04/26/2022 Health Behavior Assessment and Intervention Billing Codes REVISED
03/29/2022 Nurse First Advice Line Services Ending
03/16/2022 Revalidation Extended to June 2022 REVISED Rev. 05/13/2022
02/28/2022 COVID-19 At-Home Test Coverage
02/23/2022 Revalidation Extended to June 2022 Rev. 03/16/2022
02/23/2022 Standing Orders and Medicaid Reimbursement
02/08/2022 Vaccine Administration by Pharmacists
02/02/2022 Dose Limitations for Gabapentinoids
01/14/2022 Montana Healthcare Programs Support Services Holiday Closures
2021
12/20/2021 Plan First Updated Code List Descriptions
12/15/2021 Health Behavior Assessment and Intervention Billing Codes Rev. 04/26/2022
12/10/2021 New Provider Services Portal
11/05/2021 Pharmacy Provider License Renewal Reminder
09/24/2021 Codes Removed from and Added to Plan First Covered Code List
09/23/2021 Prior Authorization Criteria for Synagis®
09/16/2021 Billing Update - Licensed Marriage and Family Therapist (LMFT)
07/20/2021 Enrollment Update – Licensed Marriage and Family Therapist
07/09/2021 2021 Annual Montana Dispensing Fee Survey
07/06/2021 Adoption Of Temporary Emergency Rule To Allow for COVID-19-Related
Regulatory Discretion Beyond The Expiration Of The Governor-Declared State Of Emergency
06/11/2021 COVID-19 Vaccine Administration Billing Guidance
05/12/2021 2021 Average Acquisition Cost (AAC) Survey
04/26/2021 Billing for COVID-19 Vaccine
04/08/2021 Electronic Prior Authorization Process for Suboxone® Films for Medication Assisted Therapy
04/02/2021 New Provider Type – Licensed Marriage and Family Therapist
02/11/2021 Billing for COVID-19 Vaccine
01/28/2021 Montana Healthcare Programs Support Services Holiday Closures
01/21/2021 Montana Plan First Additional Codes Added to Plan First Covered Code List
01/11/2021 Provider Support Services Closed for Martin Luther King Day, Monday, January 18, 2021
2020
12/07/2020 Medicaid Expansion Extended Through December 31, 2021
12/01/2020 Change in Application Process for Plan First
11/12/2020 Removal of Codes for COVID-19 Testing and Treatment
11/10/2020 Prior Authorization Criteria for Synagis®
10/28/2020 Provider Relief Fund General Allocation
10/15/2020 Pharmacy Provider License Renewal Reminder
10/08/2020 Montana Plan First - Addition of Radiologic Examination Codes for Abdomen; 1, 2, and 3 Views
08/28/2020 Provider Relief Fund General Allocation rev. 08/28/2020
- Overview and Access Guide for Seeking Provider Relief Funding from HHS Allocation to Medicaid Providers rev. 08/28/2020
08/11/2020 Provider Relief Fund General Allocation rev. 08/11/2020
- Overview and Access Guide for Seeking Provider Relief Funding from HHS Allocation to Medicaid Providers rev. 08/11/2020
07/27/2020 Montana Plan First - Additional Covered Code, COVID - Testing
07/24/2020 Provider Relief Fund General Allocation
07/17/2020 Medicaid Reimbursement and Court Ordered Services
07/02/2020 New Required NCPDP Field
06/26/2020 Vaccine Administration by Pharmacists
06/17/2020 National Correct Coding Initiative Announcement
05/15/2020 Temporary Revision to Case Management General Provisions
04/30/2020 National Correct Coding Initiative Announcement
04/28/2020 Temporary Suspension of the PCP Referral Requirement
04/27/2020 Non-Covered Services Agreement Policy Change
04/06/2020 2020 Annual Montana Dispensing Fee Survey rev. 04/15/2020
04/06/2020 2020 Average Acquisition Cost (AAC) Survey
04/01/2020 Suspension of Face to Face Requirements for Some Medicaid Programs
03/26/2020 Montana Plan First - Additional Covered Codes, Telemedicine/Telehealth
03/20/2020 Billing for Insulin Products
03/19/2020 Telemedicine Medicaid Coverage and Reimbursement Policy for Telemedicine/Telehealth rev 03/27/2020
02/28/2020 Starting Dose and Quantity Limitations for Sedative Hypnotics
01/10/2020 Co-Payment Assessed in Error for January 6, 2020
01/03/2020 Changes to Hepatitis C Treatment Criteria
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.
MHSP Formulary 08/31/2015 (Reviewed 04/06/2022)
NCPDP Payer Sheet 04/2024