Pharmacy Services / DME

Pharmacy and Durable Medical Equipment (DME) services are administered by Medicaid's Clinical Services and Support Division. 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.

• Average Acquisition Cost (AAC) Reimbursement
• Billing and Policy Information for Providers
• Drug Utilization Review (DUR) Board
• Hemophilia Management
• Pharmacy Forms and Criteria
• Pharmaceutical Manufacturers' Information
• Pharmacy and Therapeutics Committee 
• Preferred Drug List (PDL)
• Pharmacy Prescription Limit /3 Month Supply
• Smoking Cessation Services
• Synagis - Effective 10/1/20
• Vaccine Administration
• Drug Look-Up - NDC Look Up Website

• Supplies, Appliances and Durable Medical Equipment (DME)

• ALERT - Opioid Refill Threshold Increase - 11/6/18
• All Medicaid ALERTS
• Provider Manual - Chapter 27 - Pharmacy
• Buprenorphine Primer for Prescribers and Pharmacists - CMS Guide
• Contact Information / Pharmacy Links
• Patient Assistance Programs
• Frequently Asked Questions
• Medicare Part D
  • Clicke here for Form 243a: to be used only for LTC Medical Offset for Prescription Drugs
• Pharmacist Newsletter
• Procurement

COVID-19 Updates for Alabama Medicaid Pharmacy Providers

• See Pharmacy ALERT for COVID-19 OTC and "At Home" Tests for Pharmacy Billing at this link: https://medicaid.alabama.gov/alert_detail.aspx?ID=15725 - 1/20/22
• See Pharmacy ALERT at this link: https://medicaid.alabama.gov/alert_detail.aspx?ID=13747 - 3/19/20 See Pharmacy ALERT for COVID-19 vaccine billing at this link: https://medicaid.alabama.gov/alert_detail.aspx?ID=14255 -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

Opioid Edits

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

• See ALERT at this link: https://www.medicaid.alabama.gov/alert_detail.aspx?ID=13378.
• Override Form and Criteria can be found at the following link when it is available (no criteria needed during phase-in period):  Pharmacy Forms and Criteria
• Prescribers and Pharmacists click here for the printable Recipient Information Sheet (scroll to bottom of page)
• HHS Guidance for Dosage Reduction or Discontinuation of Opioids

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

• See ALERT at this link: http://medicaid.alabama.gov/alert_detail.aspx?ID=12978.
• Override Form and Criteria can be found at the following link:  Pharmacy Forms and Criteria
• Prescribers and Pharmacists click here for the printable Recipient Information Sheet (scroll to bottom of page)