Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Pharmacy

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Provider Manuals

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.

Preferred Drug Information

Preferred Drug List  Rev. 12/10/2019

List of preferred drugs and other preferred drug list information.


Average Acquisition Cost Links

Provider Notices


01/10/2020 Co-Payment Assessed in Error for January 6, 2020

01/03/2020 Changes to Hepatitis C Treatment Criteria


12/27/2019 Elimination of Copayments
12/27/2019 Prior Authorization Criteria for Atypical Antipsychotics for Children 7 Years of Age and Under
12/16/2019 Guidance for Pharmacies Billing Prescriptions for Members in Psychiatric Residential Treatment Facilities (PRTF)
12/04/2019 Dosage Restrictions for all Opioids based on Morphine Milligram Equivalents (MME)
11/18/2019 HCPCS Modifiers - XE, XS, and XU (Reissued Notice)
11/14/2019 Prior Authorization Criteria for Synagis®
10/21/2019 Pharmacy Provider License Renewal Reminder
08/27/2019 Electronic Prior Authorization Process for Suboxone Films for Medication Assisted Therapy rev. 08/27/2019
07/25/2019 Cognitive Care Reimbursement (Revised)
07/09/2019 Vaccine Administration by Pharmacists
07/02/2019 Montana Plan First - Update to Covered Code List
06/21/2019 Electronic Prior Authorization Process for Suboxone Films for Medication Assisted Therapy
05/20/2019 Nurse Visit - Appropriate Billing Reminder - Revised Clarification rev. 05/30/2019
05/01/2019 Dosage Restrictions for all Opioids based on Morphine Milligram Equivalents (MME)
04/16/2019 2019 Annual Montana Dispensing Fee Survey
04/15/2019 2019 Average Acquisition Cost (AAC) Survey
03/25/2019 Montana Plan First - Change to Covered Procedures and Service Codes


11/30/218  Dosage Restrictions for all Opioids based on Morphine Milligram Equivalents (MME)
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) - this has been replaced with the provider notice dated 11/30/2018
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


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

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.