Pharmacy

Prior Authorization Forms Claim Jumper Newsletters

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 List 02/19/2025

List of preferred drugs and other preferred drug list information.

Montana Healthcare Programs cover the following non-prescriptions (OTC) medications manufactured by companies who have signed a federal rebate agreement.

*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*
  • Nonsedating antihistamines (as listed on PDL)
  • Nicotine patches, gum and lozenges
  • NSAID, topical (as listed on PDL)
  • Opioid reversal agents (as listed on PDL)
  • Oral contraceptives
  • Proton pump inhibitors (as listed on PDL)
  • Retinoids, topical (as listed on PDL)
  • Steroid nasal spray (as listed on PDL)
Also, Montana Healthcare Programs may cover select vitamins and minerals, regardless of rebate. Criteria may apply.

2025

05/14/2025 2025 Average Acquisition Cost (AAC) Survey
04/29/2025 Audio - Only Codes
04/23/2025 DME Claims Processing Instructions for Enteral and Parenteral Nutrition
03/31/2025 Payment To Be Suspended for Providers Without Current Financial Information
03/06/2025 Monthly Supply Allowance for Continuous Glucose Monitors - A4238 or A4239
02/11/2025 EFT Authorization Agreement Updated
02/04/2025 Health Behavior Assessment and Intervention Billing Codes
01/15/2025 Total Electric Hospital Bed Coverage Criteria
01/15/2025 Montana Healthcare Programs Support Services Holiday Closures

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

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)

To locate older documents, access the Archive Page.