Pharmacy Services / DME

COVID-19 Updates for Alabama Medicaid Pharmacy Providers

  • See Pharmacy ALERT at this link: - 3/19/20 See Pharmacy ALERT for COVID-19 vaccine billing at this link: -12/29/20
  • PDL Update: In response to the COVID-19 pandemic and reported shortages in certain areas of our state, all covered NDCs of albuterol inhaler (brand and generic) are now included/listed as preferred in the Preferred Drug List. Prior Authorization is not required; maximum unit edits still apply. Effective 3/19/20
  • Lifted the Accumulation Edit - Effective 3/19/20
  • Updated signature requirements during the state of emergency See ALERT here - Effective 3/16/20
  • Implemented a universal prior authorization (PA) number (9999999999) to override the following edits/limitations:
      • Early Refill - conflict/intervention/outcome codes are still required - Effective 3/23/20
      • Maximum Units - Effective 3/23/20
      • Mandatory Three Month Maintenance Supply - Effective 3/23/20
  • Delayed the implementation of the next MME decrease schedule for April 1, 2020
  • Allowance for approval of 30 day extensions of existing PAs to be made verbally without additional documentation - Effective 3/23/20
  • Discontinuation of audits during the state of emergency

Click here for the 9/26/19 presentation, "Medicaid Pharmacy Reimbursement".

On May 1, 2019, the Alabama Medicaid Agency implemented a "Cumulative MME Edit" for opioid-experienced recipients.

On November 1, 2018, the Alabama Medicaid Agency implemented limits on short-acting opiates for opioid naïve recipients.

Pharmacy and Durable Medical Equipment (DME) services are administered by Medicaid's Clinical Services and Support Division.  In Fiscal Year 2015, approximately 600,000 recipients received almost 7 million prescriptions.  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.

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Durable Medical Equipment (DME)
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