To: Pharmacies, Physicians, Physician Assistants, Nurse Practitioners, Oral Surgeons, Optometrists, Dentists, FQHCs, RHCs, Mental Health Service Providers, Hospitals, and Nursing Homes
Effective October 1, 2013, the Alabama Medicaid Agency will:
- Discontinue coverage of over-the-counter medications (OTCs) for adults and children; OTC insulin, 2nd generation antihistamines, and nutritional products will remain covered.
- Decrease Wholesale Acquisition Cost (WAC) ingredient reimbursement to WAC + 0% from WAC +9.2% for drugs without an Average Acquisition Cost (AAC).
Effective October 1, 2013, the Alabama Medicaid Agency will begin phasing in the following changes for an effective date of January 1, 2014. Informational edits and/or overrides will be available during the phase-in period to coordinate/find the best schedule for each individual recipient. Changes include:
Implementation of a mandatory three-month maintenance supply program for selected medication classes. A maintenance supply prescription will only be counted towards the prescription limit in the month in which it is filled. The selected classes include:
|
Medication Class |
Medications Included |
|
ACE Inhibitors |
Preferred generics and brands |
|
Antidepressants |
Preferred generics and brands |
|
Angiotensin II Receptor Blockers |
Preferred generics and brands |
|
Asthma |
Generic montelukast only |
|
Beta Blockers |
Preferred generics and brands |
|
Calcium Channel Blockers |
Preferred generics and brands |
|
Contraceptives |
Oral, vaginal rings, patches only |
|
Diabetic Agents/Supplies |
Generic metformin, OTC insulins, and syringes |
|
Diuretics |
Preferred generics and brands |
|
Lithium |
All covered Products |
|
Statins |
Preferred generics and brands |
|
Thyroid Replacement |
All covered Products |
- Limit the number of outpatient pharmacy prescriptions to five total drugs (including up to four brands) per month for adults. Children under 21 and nursing home recipients are excluded. In no case can total prescriptions exceed 10 per month per recipient. Allowances will be made for up to five additional (10 total) prescriptions for brand and generic antipsychotics, antiretrovirals, and anti-epileptic drugs.
Additonal pharmacy-specific billing information and override information can be found on the Pharmacy Services page of the Alabama Medicaid Agency website at http://www.medicaid.alabama.gov/CONTENT/4.0_Programs/4.5_Pharmacy_Services.aspx