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.
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
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Delayed the implementation of the next MME decrease schedule for April 1, 2020
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Allowance for approval of 30 day extensions of existing PAs to be made verbally without additional documentation - Effective 3/23/20
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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.
On November 1, 2018, the Alabama Medicaid Agency implemented
limits on short-acting opiates for opioid naïve recipients.