TO: Pharmacies, Physicians, Physician Assistants, Nurse Practitioners, Oral Surgeons, Optometrists, Dentists, FQHCs, RHCs, Mental Health Service Providers, and Nursing Homes

The Alabama Medicaid Agency is closely monitoring the Coronavirus Disease 2019 (COVID-19). In response, the below accommodations related to pharmacy claims will be in place for 30 days, at which time the Agency will reassess and notify our provider community. 

1.    Early Refill (ER) Edits: A universal PA number may be used when claims deny for ER. This universal override number will apply to all medications that hit the ER edit. The pharmacist should use clinical judgement when determining if the universal PA number is utilized. 

a.    The universal PA number will be: 9999999999. 

b.    This change is anticipated to be effective by Wednesday, March 25^th, or earlier. 

2.    Morphine Milligram Equivalent (MME):  The Agency will postpone the implementation of the cumulative daily MME edit decrease scheduled for April 1, 2020. Please refer to the previous ALERT here for more information.  Current MME limitations will remain in place.

3.    Preferred Drug List (PDL):  The Agency may need to make changes to the preferred drug list as a result of potential drug shortages. Non-preferred products may become preferred if shortages of preferred agents occur. Updates/changes will be maintained on the Agency website under Pharmacy/Programs/Preferred Drug List. Pharmacists are encouraged to report drug shortages to the Agency, or the contractor Myers & Stauffer, if they occur. Myers & Stauffer may be reached by clicking here. 

4.    Maintenance Supply Program:  The Alabama Board of Pharmacy (ALBOP) has implemented emergency refills for maintenance medications (see guidance here). In conjunction with the ALBOP’s guidance, Alabama Medicaid will allow overrides for maintenance supply medications. This allowance will go into effect immediately. The Medicaid override form can be found at: https://medicaid.alabama.gov/documents/9.0_Resources/9.4_Forms_Library/

9.4.14_PA_Forms/9.4.1.4_PH_PA_Form_409_Override_Fillable_7-2-18.pdf

5.    Prior Authorization (PA) Requirements:  Medicaid will allow for temporary exceptions for prior authorization renewal requests for lab values or urine drug screens that require an in-person visit with a lab or provider. This allowance will go into effect immediately and will apply to renewal requests.

Alabama Medicaid will continue to review policies and procedures as needed to ensure the safety of the public. Policy questions concerning this provider notice should be directed to the Pharmacy Program at (334) 242-5050. Questions regarding PA procedures should be directed to the HID help desk at