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Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Pharmacy

Main Content

Pharmacy

Pharmacy

Provider Manuals

General Information for Providers  06/2018

Medicaid manual with general information for all provider types.

Prescription Drug Program 07/31/2018

This manual has information specific to your provider type.

Preferred Drug Information

Preferred Drug List  Rev. 11/05/2018

List of preferred drugs and other preferred drug list information.

 

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.

2018

11/20/2018 Appropriate Billing Reminder
11/20/2018 Appropriate Billing Reminder
11/09/2018 Pharmacy Provider License Reminder
11/08/2018 Rate Updates Mass Adjustment
11/06/2018 Smart PA® Prior Authorization for Synagis®
11/06/2018 Vaccine Administration by Pharmacists
11/05/2018 Rate Restoration Mass Adjustment for Pharmacy
10/19/2018 Medicaid Fee Schedules
08/14/2018 New Universal Claim Form
07/05/2018 Dosage Restrictions For All Opioids Based On Morphine Milligram Equivalents (MME)
07/02/2018 Updated CLIA Claims Editing
06/04/2018 Coding Resources Change
04/25/2018 Changes to the Medicare Part D Drug Benefit for Dual Eligible Members – Benzodiazepines
04/24/2018 2018 Annual Montana Dispensing Fee Survey
04/24/2018 2018 Average Acquisition Cost (AAC) Survey
04/04/2018  Updated Passport Eligible Populations & Reimbursement
02/26/2018 New Rendering Only Provider Enrollment Application
02/14/2018 Third Party Payer - Negative Payment Amounts


2017

12/26/2017 MATH Web Portal Eligibility Inquiry Verification Update
12/11/2017  Montana Plan First Procedure and Service Codes - Contraceptive (IUD) Update
12/12/2017 Medication Authorization Change Regarding New Brand Name Drugs
12/11/2017 Vaccines for Children Code Update
12/01/2017 Montana Medicaid Expansion Prior Authorization Changes
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

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.