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Concerta/Methylphenidate Billing Guidance
The Food and Drug Administration (FDA) recently changed the rating of
methylphenidate ER (18, 27, 36 and 54 mg). It is no longer classified as a
generic equivalent to the brand name product Concerta. In order for
pharmacies to be reimbursed correctly, claims billed for brand named
Concerta may be billed using a DAW code of 8 (substitution allowed-generic
drug not available in the marketplace). Concerta remains non-preferred and
will continue to require prior authorization.
Medical Equipment (DME)-
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The Alabama Medicaid Agency
pays for most medicines legally prescribed by a doctor or authorized health
professional when dispensed by a licensed doctor or pharmacist in accordance
with state and federal laws.