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July 24, 2017

Pharmacy Program

 

The goal of the Medicaid Pharmacy Program is to provide quality care to Medicaid participants with the most effective drug at the right price.


Idaho Medicaid Pharmacy Call Center
(208) 364-1829 OR
toll free 1 (866) 827-9967 (available Monday through Friday 8am to 5pm, closed on federal and state holidays)
1 (800) 327-5541 (fax)

  • Initiate prior authorization requests
  • For prior authorization status inquiries, please call Magellan Medicaid Administration Pharmacy Support Center at 1 (800) 922-3987
Prior Authorization Fax
1 (800) 327-5541

Magellan Medicaid Administration Pharmacy Support Center
1 (800) 922-3987 (available 24 hours/day, 365 days/year
  • Claims processing assistance
  • Drug coverage and payment information
  • Eligibility issues or inquiries
  • Plan limitations
  • Coordination of benefits
  • Prior authorization status

Pharmacy Program News


P&T Committee Meetings in 2017

  • April 21, 2017
  • May 19, 2017
  • October 20, 2017
  • November 17, 2017
Unless otherwise posted in the agenda, meetings start at 9 am with public testimony received from 9:30 am to 10:30 am. All meetings are held at Idaho Medicaid at 3232 Elder Street in Boise.
 
DUR Board Meetings in 2017
  • February 16, 2017
  • April 20, 2017
  • July 20, 2017
  • October 19, 2017

State Holidays for 2017

  • New Years Day - January 1 (Observed January 2)
  • Martin Luther King Jr Day - January 16
  • President’s Day – February 20
  • Memorial Day – May 29
  • Independence Day – July 4
  • Labor Day – September 4
  • Columbus Day - October 9
  • Veteran's Day - November 11 (Observed November 10)
  • Thanksgiving Day - November 23
  • Christmas Holiday - December 25

Contact Info
Prior Authorization Requests (Monday through Friday 8am to 5pm)
(208) 364-1829 or toll free 1(866) 827-9967

Prior Authorization Status Inquiry (24/7, 365 days/years)
1(800) 922-3987
 
P&T Committee
Tami Eide, PharmD
(208) 364-1829
 
J-Code Questions
(208) 364-1897
 
Eligibility Questions
(800) 922-3987
 
DME (Durable Medical Equipment)
Includes diabetic supplies (e.g. test strips), nutritional supplies, incontinence supplies.
1(866) 686-4272
 
Magellan Medicaid Administration – Provider Line
1(800) 922-3987
 
Magellan Medicaid Administration – Participant Line
1(888) 773-9466
 
72 Hour Emergency Supply
 
Idaho Medicaid will pay for point-of-sale (POS) pharmacy claims for a 72 hour emergency supply of medications requiring prior authorization if the pharmacist in his/her professional judgment believes a participant has an immediate need. The appropriate prior authorization process must be used during regular business hours. All of the following conditions must be met for an emergency supply:
  • The participant is Medicaid eligible on the date of service
  • The prescription is new to the pharmacy
  • The medication requires prior authorization
  • The supply for the emergency period does not exceed three days
 The override codes for billing for a 72 hour emergency supply are:
  • Reason for Service Code: TP (Payer/Processor Question)
  • Professional Service Code: MR (Medication Review)
  • Result of Services Code: 1F (filled, with different quantity)
 A completed prior authorization request must be faxed to 800-327-5541.
 
Medicare Part D Participants
 
The only drug classes covered by Idaho Medicaid for dual eligible participants (i.e. participants who are also on Medicare) are: cough/cold medications, folic acid, injectable vitamin B12, iron, legend Vitamin D, and Vitamin K.
 
Spacers for Inhalers
 
Spacers are reimbursable by Idaho Medicaid through the DME (durable medical equipment) program and do not require prior authorization. One spacer is authorized per six months.
 
All spacers should be billed using the CMS 1500 with the following HCPC procedure codes:
  • S8100 – holding chamber or spacer used with an inhaler or nebulizer, without mask
  • S8101 – holding chamber or spacer for use with an inhaler or nebulizer, with mask