Effective April 1, 2013, the Alabama Medicaid Agency will:

1. Implement a package size edit to ensure the accuracy of the quantity dispensed for drugs that come in unconventional package sizes. This edit will prevent a claim for a medication whose dispensed quantity is not divisible by the drug’s package size from paying. This would only apply to specified drugs that are available in unconventional package sizes.  For example, a drug with a package size of 0.4ml/unit would deny if the quantity submitted on the claim was 1 unit. Providers receiving this edit should verify the package size of the product being dispensed and resubmit with the correct quantity.

2. Update the Preferred Drug List (PDL) to reflect the recent Pharmacy and Therapeutics (P&T) Committee’s recommendations as well as quarterly updates. The updates are listed below: 

For additional PDL and coverage information, visit our drug look-up site at https://www.medicaid.alabamaservices.org/ALPortal/NDC%20Look%20Up/tabId/39/Default.aspx.

The PA request form and criteria booklet, as well as a link for a PA request form that can be completed and submitted electronically online, can be found on the Agency’s website at www.medicaid.alabama.gov and should be utilized by the prescribing physician or the dispensing pharmacy when requesting a PA. Providers requesting PAs by mail or fax should send requests to:

Health Information Designs (HID)

Medicaid Pharmacy Administrative Services

P. O. Box 3210 Auburn, AL 36832-3210

Fax: 1-800-748-0116

Phone: 1-800-748-0130

Incomplete PA requests or those failing to meet Medicaid criteria will be denied. If the prescribing physician believes medical justification should be considered, the physician must document this on the form or submit a written letter of medical justification along with the prior authorization form to HID. Additional information may be requested. Staff physicians will review this information.

Policy questions concerning this provider notice should be directed to the Pharmacy Program at (334) 242-5050. Questions regarding prior authorization procedures should be directed to the HID help desk at 1-800-748-0130.