October 1, 2013

State of Alabama
Press Release: Medicaid

Pharmacy Changes (Updated from ALERT 9/5/13)

To:   Pharmacies, Physicians, Physician Assistants, Nurse Practitioners, Oral Surgeons, Optometrists, Dentists, FQHCs, RHCs, Mental Health Service Providers, Hospitals, and Nursing Homes

Effective October 1, 2013, the Alabama Medicaid Agency will:

  • Discontinue coverage of over-the-counter medications (OTCs) for adults and children; OTC insulin, 2nd generation antihistamines, and nutritional products will remain covered.
     
  • Decrease Wholesale Acquisition Cost (WAC) ingredient reimbursement to WAC + 0% from WAC +9.2% for drugs without an Average Acquisition Cost (AAC). 

Effective October 1, 2013, the Alabama Medicaid Agency will begin phasing in the following changes for an effective date of January 1, 2014. Informational edits and/or overrides will be available during the phase-in period to coordinate/find the best schedule for each individual recipient. Changes include:

Implementation of a mandatory three-month maintenance supply program for selected medication classes. A maintenance supply prescription will only be counted towards the prescription limit in the month in which it is filled. The selected classes include:

Medication Class

Medications Included

ACE Inhibitors

Preferred generics and brands

Antidepressants

Preferred generics and brands

Angiotensin II Receptor Blockers

Preferred generics and brands

Asthma

Generic montelukast only

Beta Blockers

Preferred generics and brands

Calcium Channel Blockers

Preferred generics and brands

Contraceptives

Oral, vaginal rings, patches only

Diabetic Agents/Supplies

Generic metformin, OTC insulins, and syringes

Diuretics

Preferred generics and brands

Lithium

All covered Products

Statins

Preferred generics and brands

Thyroid Replacement

All covered Products

  • Limit the number of outpatient pharmacy prescriptions to five total drugs (including up to four brands) per month for adults. Children under 21 and nursing home recipients are excluded. In no case can total prescriptions exceed 10 per month per recipient. Allowances will be made for up to five additional (10 total) prescriptions for brand and generic antipsychotics, antiretrovirals, and anti-epileptic drugs.

Additonal pharmacy-specific billing information and override information can be found on the Pharmacy Services page of the Alabama Medicaid Agency website at http://www.medicaid.alabama.gov/CONTENT/4.0_Programs/4.5_Pharmacy_Services.aspx



  • For more information, visit http://medicaid.alabama.gov
  • For more state-wide press releases, click here