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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 2014

  • April 18, 2013
  • May 23, 2014 (This date was originally May 16 and has changed to the 23rd)
  • October 17, 2014
  • November 14, 2014 (This date was originally November 21 and has changed to the 14th)
Unless otherwise posted in the agenda, meetings start at 9am with public testimony received from 9:30am to 10:30am. All meetings are held at Idaho Medicaid at 3232 Elder Street in Boise.
 
DUR Board Meetings in 2014
  • January 16, 2014
  • April 17, 2014
  • July 17, 2014
  • October 16, 2014

State Holidays for 2014

  • New Years Day - January 1
  • Martin Luther King Jr Day - January 20
  • President’s Day – February 17
  • Memorial Day – May 26
  • Independence Day – July 4
  • Labor Day – September 1
  • Columbus Day - October 13
  • Veteran's Day - November 11
  • Thanksgiving Day - November 27
  • 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
Jeanne Siroky
(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