PDF Version
TO: All Pharmacies, Physicians, Physicians Assistants, Nurse Practitioners,
FQHCs and RHCs
In an effort to address the hepatitis A
outbreak in our state, effective February 1, 2019 Alabama Medicaid will begin
reimbursing Medicaid-enrolled pharmacy providers for the administration of
hepatitis A vaccine to eligible recipients age 19 and older. Alabama Medicaid
will, in addition to the administration reimbursement, reimburse pharmacies for
the hepatitis A vaccine (i.e. ingredient).
- Beginning February 1, pharmacy providers may bill
the following NDC number on a pharmacy claim for reimbursement of vaccine
administration:
- NDC 99999-9994-11 for hepatitis A administration
- Reimbursement will be $5 per administration with no
dispensing fee or co-pay applied.
- Claims should be submitted with a dispense quantity
of 1 for vaccine administration. There is a maximum quantity for each
administration of 1 injection per recipient within a timeframe in
accordance with the CDC dosing regimen.
- A prescription from a recipient’s Primary Medical
Provider (PMP) is required for each hepatitis A vaccine administration.
- To
facilitate coordination of care, Pharmacy providers are required to
inform (via phone, fax, e-mail, mail) each recipient’s Primary Medical
Provider (PMP) upon administration of the vaccine(s) for which an
administration claim is submitted. Documentation must be kept on file at
the pharmacy of the notification to the PMP. If the PMP is unknown, the
pharmacy may call the Alabama Medicaid Automated Voice Response System
(AVRS) at 1-800-727-7848 to obtain the PMP information. A suggested
Immunization Provider Notification Letter, which can be used to notify
the PMP, can be found on the Agency website at
http://www.medicaid.alabama.gov/content/4.0_Programs/4.3_Pharmacy-DME/4.3.11_Vaccine_Admin.aspx.
- Alabama State Board of Pharmacy law and regulation should be followed regarding dispensing and administration of legend drugs/vaccines.
- A separate claim for the vaccine (i.e. ingredient) should be submitted with the appropriate NDC of the vaccine (i.e. ingredient) and will be reimbursed according to the current drug/pharmacy reimbursement policy.
The Current Procedural Terminology (CPT) and Current Dental Terminology
(CDT) codes descriptors, and other data are copyright © 2019
American Medical Association and © 2019 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.
To facilitate coordination of care, Pharmacy providers are required to inform (via phone, fax, e-mail, mail) each recipient’s Primary Medical Provider (PMP) upon administration of the vaccine(s) for which an administration claim is submitted. Documentation must be kept on file at the pharmacy of the notification to the PMP. If the PMP is unknown, the pharmacy may call the Alabama Medicaid Automated Voice Response System (AVRS) at 1-800-727-7848 to obtain the PMP information. A suggested Immunization Provider Notification Letter, which can be used to notify the PMP, can be found on the Agency website at