To: Pharmacy Providers

With the implementation of the Medicare Part D program, it is important to recognize Medicare covers certain prescription drugs under Part B with J codes (HCPC Codes) instead of NDC codes. Medicaid will allow these claims to be billed secondary to Medicare effective January 1, 2006. Examples of these drugs include hemophilia clotting factors, some immunosuppressive drugs for transplant patients (if the transplant was paid for by Medicare), some oral cancer drugs, erythropoietin analogs if the patient has End Stage Renal Disease, some injectable osteoporosis drugs, and some antigens if they are administered under doctor supervision. For more information on this issue, please visit the CMS website at:

http://www.medicare.gov/Coverage/Search/Results.asp?State=AL%7CAlabama&Coverage=51%7CPrescription+Drugs&submitState=View+Results+%3E.

If the Alabama Medicaid pharmacy provider does not already have a provider number for filing Part B crossover claims, then the pharmacy provider will need to complete a separate provider enrollment application in order to be allowed to bill for these services secondary to Medicare. Medicaid allows payment up to our allowed amount. Providers will be issued an additional pharmacy provider number, which will be used for filing secondary claims only.

The Enrollment application can be found on our website at: http://www.medicaid.alabama.gov/ and click on Billing>Forms-Billing Related>Provider Enrollment Forms, and should be utilized by pharmacy providers that will be billing for Part B claims. Enrollment applications should be mailed to:

EDS

Provider Enrollment

P.O. Box 244032

Montgomery, Al 36124

Any questions concerning the applications should be directed to provider enrollment at 1-800-223-3630.

Once a provider number is received, Part B claims should crossover automatically to Medicaid from Medicare. However, if the Part B crossover claim did not crossover automatically, then the Part B crossover claim should be filed on a Medicaid/Medicare related claim form, or electronically through Provider Electronic Solutions software. Claim forms and software can be ordered by calling Provider Assistance at 1-800-688-

7989.