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Manuals
Item Last Modified
Pharmacy Provider Billing Manual 10/02/2015
Trading Partners FTP Instructions 07/14/2015
MEUPS Provider Sign-in Instructions 06/25/2014
Web Claim Submission (WCS) User Guide 06/27/2014
Payer Specs
2015 Last Modified
D.0 Payer Specs 11/11/2015
Drug Lists
Item Last Modified
Diabetic Supply Preferred Drug List (effective 10/01/2015) 10/14/2015
Contacts
  • Prior Authorization
    1-800-477-3071
  • Claim Inquiry
    1-800-432-7005

Please note questions regarding claims prior to October 5, 2010 should be directed to 1-800-807-1232.

Education
Title Last Modified
Diabetic Supply FAQs 04/03/2015
Provider Notices
Title Description Last Modified
Pharmacy Provider Notice #110 Diabetic Supplies 09/17/2010
Drug Management Review Advisory Board
Item Last Modified
Information about the Drug Management Review Advisory Board External URL
Forms
Item Last Modified
DMRAB Speaker Request Form - PDF 12/04/2015
DMRAB Speaker Request Form - Word 12/04/2015
This Year’s Meetings
March 9, 2016 Last Modified
Cancelled due to lack of quorum N/A
Previous Year’s Meetings
March 10, 2016 Last Modified
Cancelled due to lack of quorum N/A
September 10, 2015 Last Modified
Cancelled due to lack of quorum N/A
June 11, 2015 Last Modified
Cancelled due to lack of quorum N/A
March 12, 2015 Last Modified
Cancelled due to lack of quorum N/A
Member List
Item Last Modified
DMRAB Member List 12/04/2015
Directions
Item Last Modified
Capitol Annex Directions 06/09/2014
Frankfort, KY Map 04/26/2010
Drug Management Review Advisory Board Archives
September 10, 2015 Last Modified
Cancelled due to lack of quorum N/A
June 11, 2015 Last Modified
Cancelled due to lack of quorum N/A
March 12, 2015 Last Modified
Cancelled due to lack of quorum N/A
December 11, 2014 Last Modified
Cancelled due to lack of quorum N/A
September 11, 2014 Last Modified
Cancelled due to lack of quorum N/A
June 12, 2014 Last Modified
Cancelled due to lack of quorum N/A
March 13, 2014 Last Modified
Cancelled due to lack of quorum N/A
November 14, 2013 Last Modified
Cancelled due to lack of quorum N/A
August 08, 2013 Last Modified
Agenda 07/24/2013
Cancelled due to lack of quorum N/A
May 09, 2013 Last Modified
Agenda 04/22/2013
Cancelled due to lack of quorum N/A
February 14, 2013 Last Modified
Agenda 01/28/2013
Cancelled due to lack of quorum N/A
November 08, 2012 Last Modified
Agenda 10/17/2012
Recommendations for Consideration 10/17/2012
Cancelled due to lack of quorum N/A
August 09, 2012 Last Modified
Agenda 07/24/2012
Recommendations for Consideration 07/24/2012
Cancelled due to lack of quorum N/A
May 10, 2012 Last Modified
Agenda 04/24/2012
Recommendations for Consideration 04/24/2012
Cancelled due to lack of quorum N/A
February 09, 2012 Last Modified
Agenda 01/24/2012
Recommendations for Consideration 01/24/2012
Cancelled due to lack of quorum N/A
November 10, 2011 Last Modified
Agenda 10/27/2011
Recommendations for Consideration 10/27/2011
Cancelled due to lack of quorum N/A
August 11, 2011 Last Modified
Agenda 07/25/2011
Committee Recommendations 12/02/2011
Final Decisions 12/02/2011
May 12, 2011 Last Modified
Agenda 04/22/2011
Minutes 08/18/2011
Presentation 08/16/2011
Drug to Drug Interactions Recommendations 04/22/2011
February 10, 2011 Last Modified
Agenda 01/26/2011
Drug to Drug Interactions Recommendations 01/26/2011
Cancelled due to lack of quorum N/A
November 04, 2010 Last Modified
Agenda 10/19/2010
Minutes 08/18/2011
Presentation 05/20/2011
August 12, 2010 Last Modified
Agenda 07/26/2010
Minutes 08/18/2011
Presentation 11/24/2010
May 13, 2010 Last Modified
Agenda 11/24/2010
Minutes 11/24/2010
Presentation 11/24/2010

General Information

Drug Information
Item Last Modified
Covered Prescription Cold, Cough, and Vitamin Product List (effective 04/15/2014) 05/05/2015
Maximum Quantity Limits List (effective 06/02/2016) 06/06/2016
Over-The-Counter (OTC) Drug List 08/28/2015
Preferred Drug List (PDL) current
Kentucky Medicaid Diagnosis Drug List 12/04/2015
Kentucky Medicaid Active Labelers
2017 Last Modified
Active Labelers 2Q2017 08/16/2017
Active Labelers 1Q2017 08/16/2017
2016 Last Modified
Active Labelers 4Q2016 08/16/2017
Active Labelers 3Q2016 01/11/2017
Active Labelers 2Q2016 09/09/2016
Active Labelers 1Q2016 09/09/2016
2015 Last Modified
Active Labelers 4Q2015 05/10/2016
Active Labelers 3Q2015 01/06/2016
Active Labelers 2Q2015 10/14/2015
Active Labelers 1Q2015 07/07/2015
2014 Last Modified
Active Labelers 4Q2014 04/03/2015
Active Labelers 3Q2014 01/06/2015
Active Labelers 2Q2014 01/06/2015
Active Labelers 1Q2014 07/10/2014
2013 Last Modified
Active Labelers 4Q2013 04/29/2014
Active Labelers 3Q2013 04/29/2014
Active Labelers 2Q2013 04/29/2014
Active Labelers 1Q2013 07/05/2013
2012 Last Modified
Active Labelers 4Q2012 03/25/2013
Active Labelers 3Q2012 12/11/2012
Active Labelers 2Q2012 08/27/2012
Active Labelers 1Q2012 05/24/2012
2011 Last Modified
Active Labelers 4Q2011 03/01/2012
Active Labelers 3Q2011 01/17/2012
Active Labelers 2Q2011 08/18/2011
Active Labelers 1Q2011 07/14/2011

Maximum Allowable Cost

Title Last Modified
Maximum Allowable Cost (MAC) list Monthly Update
Maximum Allowable Cost (MAC) Listing - (Weekly Changes) Wednesday Update
MAC Price Research Request Form 10/03/2012
Provider Notifications
Title Description Last Modified
Pharmacy Quarterly Newsletter Volume 2, Number 1 02/16/2011
Pharmacy Provider Notice #120 NCPDP Version D.0 01/06/2011
Pharmacy Quarterly Newsletter Volume 1, Number 1 11/09/2010
Education
Title Description Last Modified
https://questions.cms.gov/ CMS Website - Frequently Asked Questions
Use “Search” feature to look-up D.0/5010 information
11/11/2010
NCPDP D.0 FAQs Kentucky Medicaid's Frequently Asked Questions 11/14/2011
NCPDP Resources
Title Description Last Modified
https://www.ncpdp.org NCPDP Website - To purchase implementation guides and access technical questions 11/11/2010
http://www.ncpdp.org/NCPDP/media/pdf/VersionDQuestionsv26.pdf NCPDP Website - Version D Editorial 11/11/2010
CMS Resources
Title Description Last Modified
http://www.cms.gov/Versions5010andD0 CMS Website - Central Version 5010 and D.0 Webpage 11/11/2010
http://www.cms.gov/Versions5010andD0/40_Educational_Resources.asp CMS Website - Educational Resources 11/11/2010
http://www.cms.gov/MFFS5010D0 CMS Website - Dedicated HIPAA 5010/D.0 Project Web Page 11/11/2010
http://www.cms.gov/TransactionCodeSetsStands/ CMS Website - Transactions and Code Sets Standards 11/11/2010
Additional Resources
Title Description Last Modified
http://www.hipaa-dsmo.org Designated Standard Maintenance Organizations (DSMO) Website - Request changes to standards 11/11/2010
Presentations
Title Last Modified
Kentucky Medicaid Pharmacy 3Q2012 Webinar 11/02/2012
Kentucky Medicaid Pharmacy 1Q2011 Webinar 03/30/2011
Current Notices
Title Description Last Modified
Fee-For-Service Pharmacy Provider Notice #221 State Maximum Allowable Cost Price Error 06/26/2017
Fee-For-Service Pharmacy Provider Notice #220 Universal Prescription Drug PA Request Forms 05/16/2017
Fee-For-Service Pharmacy Provider Notice #219 Actual Acquisition Cost Reimbursement for Fee-for-Service Covered Outpatient Drugs 05/16/2017
Fee-For-Service Pharmacy Provider Notice #218 Departments Message Concerning Pharmacy Reimbursement 03/27/2017
Fee-For-Service Pharmacy Provider Notice #217 Narcan® Nasal Spray (naloxone HCl) 12/19/2016
Fee-For-Service Pharmacy Provider Notice #216 March 2016 PDL Changes 12/19/2016
Fee-For-Service Pharmacy Provider Notice #215 January 2016 PDL Changes 12/19/2016
Fee-For-Service Pharmacy Provider Notice #214 Non-Rebate Eligible Products 11/04/2016
Fee-For-Service Pharmacy Provider Notice #213 Non-Rebate Eligible Products 09/09/2016
Fee-For-Service Pharmacy Provider Notice #212 Non-Rebate Eligible Products 09/09/2016
Fee-For-Service Pharmacy Provider Notice #211 November 19, 2015 P&T PDL Changes 05/10/2016
Fee-For-Service Pharmacy Provider Notice #210 Departments Message Concerning Benefind 03/31/2016
Fee-For-Service Pharmacy Provider Notice #209 November/December/January Pharmacy Updates and Upcoming Changes 03/04/2016
Fee-For-Service Pharmacy Provider Notice #208 September 17, 2015 P & T PDL Changes 01/06/2016
Fee-For-Service Pharmacy Provider Notice #207 Senate Bill 44 (Medication Synchronization) 12/04/2015
Fee-For-Service Pharmacy Provider Notice #206 October Pharmacy Updates and Upcoming Changes 12/04/2015
Fee-For-Service Pharmacy Provider Notice #205 September Pharmacy Updates and Upcoming Changes 10/14/2015
Fee-For-Service Pharmacy Provider Notice #204 July 16, 2015 P & T PDL Changes 10/14/2015
Fee-For-Service Pharmacy Provider Notice #203 August Pharmacy Updates and Upcoming Changes 09/24/2015
Fee-For-Service Pharmacy Provider Notice #202 July Pharmacy Updates and Upcoming Changes 08/19/2015
Fee-For-Service Pharmacy Provider Notice #201 May 21, 2015 P & T PDL Changes 07/28/2015
Fee-For-Service Pharmacy Provider Notice #200 May/June Pharmacy Updates and Upcoming Changes 07/14/2015
Fee-For-Service Pharmacy Provider Notice #199 March 19, 2015 P & T PDL Changes 05/13/2015
Fee-For-Service Pharmacy Provider Notice #198 April Pharmacy Updates 05/05/2015
Fee-For-Service Pharmacy Provider Notice #197 March Pharmacy Updates 04/21/2015
Fee-For-Service Pharmacy Provider Notice #196 Pharmacy Drug Pricing & Reimbursement 04/03/2015
Fee-For-Service Pharmacy Provider Notice #195 Tobacco Cessation Changes 04/03/2015
Fee-For-Service Pharmacy Provider Notice #194 February Pharmacy Updates and Upcoming Changes 03/16/2015
Fee-For-Service Pharmacy Provider Notice #193 January 15, 2015 P&T PDL Changes 03/02/2015
Fee-For-Service Pharmacy Provider Notice #192 January Pharmacy Updates and Upcoming Changes 02/18/2015
Fee-For-Service Pharmacy Provider Notice #191 December Pharmacy Updates and Upcoming Changes 01/09/2015
Fee-For-Service Pharmacy Provider Notice #190 November 20, 2014 P&T PDL Changes 01/09/2015
Fee-For-Service Pharmacy Provider Notice #189 October and November Pharmacy Updates and Upcoming Changes 12/22/2014
Fee-For-Service Pharmacy Provider Notice #188 September 18, 2014 P&T PDL Changes 11/06/2014
Fee-For-Service Pharmacy Provider Notice #187 September Pharmacy Updates 10/15/2014
Fee-For-Service Pharmacy Provider Notice #186 August Pharmacy Updates 09/23/2014
Fee-For-Service Pharmacy Provider Notice #185 July Pharmacy Updates 08/15/2014
Fee-For-Service Pharmacy Provider Notice #184 Cost-Sharing Update 07/23/2014
Fee-For-Service Pharmacy Provider Notice #183 June Pharmacy Updates 07/23/2014
Fee-For-Service Pharmacy Provider Notice #182 March 20, 2014 P&T PDL Changes 07/10/2014
Fee-For-Service Pharmacy Provider Notice #181 May Pharmacy Updates and Upcoming Changes 06/13/2014
Fee-For-Service Pharmacy Provider Notice #180 Web Portal Announcement 06/06/2014
Fee-For-Service Pharmacy Provider Notice #179 April Pharmacy Updates and Upcoming Changes 05/30/2014
Fee-For-Service Pharmacy Provider Notice #178 March Pharmacy Updates and Upcoming Changes 04/17/2014
Fee-For-Service Pharmacy Provider Notice #177 February Pharmacy Updates and Upcoming Changes 03/12/2014
Fee-For-Service Pharmacy Provider Notice #176 January Pharmacy Updates and Upcoming Changes 02/13/2014
Fee-For-Service Pharmacy Provider Notice #175 November 21, 2013 PTAC PDL Changes 02/13/2014
Fee-For-Service Pharmacy Provider Notice #174 December Pharmacy Updates and Upcoming Changes 01/14/2014
Fee-For-Service Pharmacy Provider Notice #173 September 19, 2013 PTAC PDL Changes 01/06/2014
Fee-For-Service Pharmacy Provider Notice #172 2014 Plan Design Changes 12/16/2013
Fee-For-Service Pharmacy Provider Notice #171 November Pharmacy Updates and Upcoming Changes 12/10/2013
Fee-For-Service Pharmacy Provider Notice #170 October Pharmacy Updates and Upcoming Changes 11/07/2013
Fee-For-Service Pharmacy Provider Notice #169 September Updates 10/10/2013
Fee-For-Service Pharmacy Provider Notice #168 August Pharmacy Updates and Upcoming Changes 09/16/2013
Fee-For-Service Pharmacy Provider Notice #167 July Pharmacy Updates and Upcoming Changes 09/10/2013
Fee-For-Service Pharmacy Provider Notice #166 June Pharmacy Updates 08/08/2013
Fee-For-Service Pharmacy Provider Notice #165 Upcoming Pharmacy Updates 07/16/2013
Fee-For-Service Pharmacy Provider Notice #164 March 21, 2013 PTAC PDL Changes 07/16/2013
Fee-For-Service Pharmacy Provider Notice #163 May Updates 06/27/2013
Fee-For-Service Pharmacy Provider Notice #162 April Updates and Upcoming Changes 05/17/2013
Fee-For-Service Pharmacy Provider Notice #161 March Pharmacy Updates 05/03/2013
Fee-For-Service Pharmacy Provider Notice #160 February Pharmacy Updates 03/27/2013
Fee-For-Service Pharmacy Provider Notice #159 January Pharmacy Updates 02/28/2013
Fee-For-Service Pharmacy Provider Notice #158 November 15, 2012 PTAC PDL Changes 01/21/2013
Fee-For-Service Pharmacy Provider Notice #157 December Updates and Upcoming Changes 01/11/2013
Fee-For-Service Pharmacy Provider Notice #156 November Pharmacy Updates 12/21/2012
Fee-For-Service Pharmacy Provider Notice #155 October Pharmacy Updates and Upcoming Changes 11/30/2012
Fee-For-Service Pharmacy Provider Notice #154 September Pharmacy Updates 10/25/2012
Fee-For-Service Pharmacy Provider Notice #153 July 19, 2012 PTAC PDL Changes 09/27/2012
Fee-For-Service Pharmacy Provider Notice #152 August Pharmacy Updates 09/19/2012
Fee-For-Service Pharmacy Provider Notice #151 July Pharmacy Updates 08/30/2012
Fee-For-Service Pharmacy Provider Notice #150 June Pharmacy Updates 08/01/2012
Fee-For-Service Pharmacy Provider Notice #149 May Pharmacy Updates and Upcoming Changes 06/15/2012
Fee-For-Service Pharmacy Provider Notice #148 Upcoming Changes for Cold, Cough, and Vitamin Prescriptions 05/25/2012
Fee-For-Service Pharmacy Provider Notice #147 April Pharmacy Updates 05/22/2012
Fee-For-Service Pharmacy Provider Notice #146 March 15, 2012 PTAC PDL Changes — effective beginning 06/06/2012 05/10/2012
Fee-For-Service Pharmacy Provider Notice #145 March Pharmacy Updates 04/26/2012
Fee-For-Service Pharmacy Provider Notice #144 February Pharmacy Updates 03/26/2012
Pharmacy Provider Notice #143 Upcoming Pharmacy Changes 03/01/2012
Pharmacy Provider Notice #142 January Updates 03/01/2012
Pharmacy Provider Notice #141 December Updates and Upcoming Changes 01/27/2012
Pharmacy Provider Notice #140 October Updates and Upcoming Changes 11/21/2011
Pharmacy Provider Notice #139 September Updates 10/26/2011
Pharmacy Provider Notice #138 July 21, 2011 PTAC PDL Changes 09/28/2011
Pharmacy Provider Notice #137 August Updates 09/21/2011
Pharmacy Provider Notice #136 Average Whole Price (AWP) to Wholesale Acquisition Cost (WAC) 09/30/2011
Pharmacy Provider Notice #135 July Updates and Upcoming Changes 08/19/2011
Pharmacy Provider Notice #134 May 19, 2011 PTAC PDL Changes — effective beginning 08/24/2011 07/22/2011
Pharmacy Provider Notice #133 June Updates and Upcoming Changes 07/11/2011
Pharmacy Provider Notice #132 Reminder for NCPDP Version D.0 Implementation 06/29/2011
Pharmacy Provider Notice #131 April and May Updates and Upcoming Changes 06/15/2011
Pharmacy Provider Notice #130 Non-Medicaid Providers Edit 06/09/2011
Pharmacy Provider Notice #129 March 17, 2011 PTAC PDL Changes — effective beginning 06/15/2011 05/20/2011
Pharmacy Provider Notice #128 Atypical Antipsychotics PTAC PDL Changes from the 11/18/2010 PTAC Meeting 05/06/2011
Pharmacy Provider Notice #127 March Updates and Upcoming Changes 04/22/2011
Pharmacy Provider Notice #126 Retraction to Pharmacy Provider Notice #125 04/13/2011
Pharmacy Provider Notice #125 Atypical Antipsychotics PDL Changes from the November 2010 PTAC Meeting 03/08/2011
Pharmacy Provider Notice #124 February Pharmacy Updates 03/04/2011
Pharmacy Provider Notice #123 January Pharmacy Updates and Upcoming Changes 02/16/2011
Pharmacy Provider Notice #122 Multi-Ingredient Compound Billing 01/26/2011
Pharmacy Provider Notice #121 December Pharmacy Updates 01/26/2011
Pharmacy Provider Notice #120 NCPDP Version D.0 01/06/2011
Pharmacy Provider Notice #119 November 18, 2010 PTAC PDL Changes - effective beginning 02/08/2011 01/06/2011
Pharmacy Provider Notice #118 November Pharmacy Updates and Upcoming Changes 12/21/2010
Pharmacy Provider Notice #117 October Pharmacy Updates and Upcoming Changes 11/29/2010
Pharmacy Provider Notice #116 Tobacco Cessation Program Coverage 12/01/2010
Pharmacy Provider Notice #115 PDL Changes September 2010 PTAC Meeting — effective beginning 12/01/2010 11/01/2010
Pharmacy Provider Notice #114 September Updates and Changes 11/01/2010
Pharmacy Provider Notice #113 Tobacco Cessation — 3 Brand/4 Script Limitations 10/19/2010
Pharmacy Provider Notice #112 UPDATE: Non-Medicaid Prescribers 09/30/2010
Pharmacy Provider Notice #111 August Pharmacy Updates 09/24/2010
Pharmacy Provider Notice #110 Diabetic Supplies 09/17/2010
Pharmacy Provider Notice #109 July Pharmacy Updates 08/18/2010
Pharmacy Provider Notice #108 PDL Changes from May 2010 PTAC Meeting — effective beginning 09/08/2010 08/05/2010
Pharmacy Provider Notice #107 Early Refill and OTC Changes 07/22/2010
Pharmacy Provider Notice #106 June Pharmacy Updates 07/14/2010
Pharmacy Provider Notice #105 Pharmacy License Update 07/12/2010
Pharmacy Provider Notice #104 Upcoming Pharmacy Changes 07/07/2010
Pharmacy Provider Notice #103 May Updates & Norditropin FlexPro 06/11/2010
Pharmacy Provider Notice #102 Retraction to Provider Notice #099 - April Pharmacy Updates 05/27/2010
Pharmacy Provider Notice #101 PDL Changes from March 2010 PTAC - beginning 06/23/2010 05/19/2010
Pharmacy Provider Notice #099 April Pharmacy Updates 05/07/2010
Pharmacy Provider Notice #098 PDL Changes from November PTAC Meeting — effective 05/19/2010 & March Updates 04/14/2010
Pharmacy Provider Notice #097 PDL Changes from November PTAC Meeting — effective 05/12/2010 04/07/2010
Pharmacy Provider Notice #096 PDL Changes from November PTAC Meeting — effective 05/05/2010 04/01/2010
Pharmacy Provider Notice #095 PDL Changes From November PTAC Meeting - effective 04/28/2010 & DiaStat QL 03/26/2010
Pharmacy Provider Notice #094 February Pharmacy Updates 03/12/2010
Pharmacy Provider Notice #093 PDL Changes from September PTAC Meeting — effective 04/14/2010 & 04/21/2010 03/12/2010
Pharmacy Provider Notice #092 PDL Changes from September PTAC Meeting — effective 03/31/2010 & 04/07/2010 03/05/2010
Pharmacy Provider Notice #091 PDL Changes from September PTAC Meeting — effective 03/17/2010 & 03/24/2010 02/17/2010
Pharmacy Provider Notice #090 Retraction to Provider Notice #89 - December Pharmacy Updates 02/05/2010
Pharmacy Provider Notice #089 December Pharmacy Updates 01/29/2010
Pharmacy Provider Notice #088 PDL Changes from July PTAC Meeting - effective 01/27/2010 (November 2009 Updates) 12/23/2009
Pharmacy Provider Notice #087 PDL Changes from July PTAC Meeting - effective 01/20/2010 12/18/2009
Pharmacy Provider Notice #086 PDL Changes from July PTAC Meeting - effective 01/13/2010 12/11/2009
Pharmacy Provider Notice #085 October Pharmacy Updates 12/01/2009
Pharmacy Provider Notice #084 PDL Changes from April PTAC Meeting - effective 12/02/2009 11/02/2009
Pharmacy Provider Notice #083 PDL Changes from April PTAC Meeting - effective 11/18/2009 10/16/2009
Pharmacy Provider Notice #082 PDL Changes from April PTAC Meeting - effective 11/11/2009 10/12/2009
Pharmacy Provider Notice #081 September Pharmacy Updates 10/08/2009
Pharmacy Provider Notice #080 PDL Changes from March PTAC Meeting - effective 10/28/2009 09/25/2009
Pharmacy Provider Notice #079 PDL Changes from March PTAC Meeting — effective 10/21/2009 09/17/2009
Pharmacy Provider Notice #078 PDL Changes from March PTAC Meeting — effective 10/14/2009 / August Updates 09/11/2009
Pharmacy Provider Notice #077 PDL Changes from March PTAC Meeting — effective 10/07/2009 09/03/2009
Pharmacy Provider Notice #076 Synagis Change 08/26/2009
Pharmacy Provider Notice #075 July Pharmacy Updates 08/21/2009
Pharmacy Provider Notice #074 June Pharmacy Updates 08/10/2009
Pharmacy Provider Notice #073 Prevacid SoluTab Change 07/24/2009
Pharmacy Provider Notice #072 Invega Change 07/07/2009
Pharmacy Provider Notice #071 May Pharmacy Updates 06/12/2009
Pharmacy Provider Notice #070 April Pharmacy Updates 05/22/2009
Pharmacy Provider Notice #069 March Pharmacy Updates 05/22/2009
Pharmacy Provider Notice #068 PDL Changes from Oct/Nov PTAC Meetings 05/07/2009
Pharmacy Provider Notice #067 February Pharmacy Updates 04/01/2009
Pharmacy Provider Notice #066 January Pharmacy Updates 03/04/2009
Pharmacy Provider Notice #065 (Replaces Provider Notice #64) NPI Final Implementation Phase Update 02/19/2009
Pharmacy Provider Notice #064 NPI Final Implementation Phase 02/05/2009
Pharmacy Provider Notice #063 October Pharmacy Updates 11/17/2008
Pharmacy Provider Notice #062 Prescriber NPI Notification 10/08/2008
Pharmacy Provider Notice #061A Tamper-Resistant Prescription Pad Update 02/15/2011
Pharmacy Provider Notice #061 Levaquin Change 09/11/2008
Pharmacy Provider Notice #060 Lipitor Change 08/26/2008
Pharmacy Provider Notice #059 Payment Cycle Notice 05/30/2008
Pharmacy Provider Notice #058A Tamper-Resistant Prescription Pad Policy Clarification 10/07/2009
Pharmacy Provider Notice #058 NPI Notification 04/16/2008
Pharmacy Provider Notice #057A Tamper-Resistant Prescription Pad Pharmacist Fact Sheet 02/15/2011
Pharmacy Provider Notice #057 Tamper-Resistant Prescription Pad Update 03/25/2008
Historical Notices
Title Description Last Modified
Pharmacy Provider Notice #056 Spiriva Change 12/28/2007
Pharmacy Provider Notice #055 Revised Kentucky Mental Health Chart 11/01/2007
Pharmacy Provider Notice #054 Tamper-Resistant Prescription Pad Requirements (Includes FAQ & Answers) 09/18/2007
Pharmacy Provider Notice #053 Recent and Upcoming Preferred Drug List Changes 09/14/2007
Pharmacy Provider Notice #052 Pharmacy License Update Reminder — Replacing Provider Notice #051 08/29/2007
Pharmacy Provider Notice #051 Pharmacy License Update Reminder 08/07/2007
Pharmacy Provider Notice #050 Recent and Upcoming Preferred Drug List Changes 07/25/2007
Pharmacy Provider Notice #049 Mirapex Change 07/16/2007
Pharmacy Provider Notice #048 Recent and Upcoming Preferred Drug List Changes 05/07/2007
Pharmacy Provider Notice #047 National Provider Identifier (NPI) Information 05/02/2007
Pharmacy Provider Notice #046 Pharmacy Provider Payment 04/17/2007
Pharmacy Provider Notice #045 Recent and Upcoming Preferred Drug List Changes 04/10/2007
Pharmacy Provider Notice #044 Federal Poverty Level Indicator 03/09/2007
Pharmacy Provider Notice #043 Updated Mental Health Provider Quick Reference — replacing Provider Notice #039 02/21/2007
Pharmacy Provider Notice #042 Recent and Upcoming Preferred Drug List Changes 02/08/2007
Pharmacy Provider Notice #041 Recent and Upcoming Preferred Drug List Changes 01/22/2007
Pharmacy Provider Notice #040 Zocor/simvastatin Changes 01/04/2007
Pharmacy Provider Notice #039 Updated Mental Health Provider Quick Reference - Replacing Provider Notice #031 11/16/2006
Pharmacy Provider Notice #038 Drug Exclusion List for 4-Prescription Drug Limit 11/14/2006
Pharmacy Provider Notice #037 Tier 3 Pharmacy Copayment Limited to $20 Maximum 09/26/2006
Pharmacy Provider Notice #036 Pregnancy Indicator, Thyroid Exclusion, & Plavix Generics 09/18/2006
Pharmacy Provider Notice #035 Billing Units and PDL Updates 09/05/2006
Pharmacy Provider Notice #034 4-Prescription Limit & 3-Brand Allowance Changes 08/18/2006
Pharmacy Provider Notice #033 KyHealth Choices Fax Number Update 07/20/2006
Pharmacy Provider Notice #032 Four Prescription Limit Audit Update 07/21/2006
Pharmacy Provider Notice #031 Updated Mental Health Quick Reference — Replacing Provider Notice #026 07/19/2006
Pharmacy Provider Notice #030 Member Cost Sharing Policy Update 07/12/2006
Pharmacy Provider Notice #029 June Provider Payment Change 06/20/2006
Pharmacy Provider Notice #028 Prescribing Antidepressants 06/15/2006
Pharmacy Provider Notice #027 KyHealth Choices Co-Payment Changes 06/02/2006
Pharmacy Provider Notice #026 Updated Mental Health Quick Reference — Replacing Provider Notice #018 06/02/2006
Pharmacy Provider Notice #025 Out-of-Pocket Maximum Misprint 05/22/2006
Pharmacy Provider Notice #024 Drug Updates: Revatio, Zofran, Anzemet, and Omeprazole 04/27/2006
Pharmacy Provider Notice #023 Prior Authorization Process for 4 Script Limit 03/23/2006
Pharmacy Provider Notice #022 4 Prescription Drug Limit Clarification 02/28/2006
Pharmacy Provider Notice #021 4 Prescription Drug Limit 02/09/2006
Pharmacy Provider Notice #020 Preferred Drug List Changes 02/10/2006
Pharmacy Provider Notice #019 Revised MAC List 01/13/2006
Pharmacy Provider Notice #018 Mental Health Quick Reference 12/20/2005
Pharmacy Provider Notice #017 Preferred Drug List Changes 12/15/2005
Pharmacy Provider Notice #016 Medicaid to Medicare Part D Transition 12/07/2005
Pharmacy Provider Notice #015 Accolate, Singulair & Xopenex Update 12/06/2005
Pharmacy Provider Notice #014   08/31/2005
Pharmacy Provider Notice #013   08/01/2005
Pharmacy Provider Notice #012A Long Term Care Billing for Scheduled Drugs 12/14/2005
Pharmacy Provider Notice #012   02/28/2005
Pharmacy Provider Notice #011   02/08/2005
Pharmacy Provider Notice #010   01/12/2005
Pharmacy Provider Notice #009   12/23/2004
Pharmacy Provider Notice #008   12/21/2004
Pharmacy Provider Notice #007   12/21/2004
Pharmacy Provider Notice #006   12/17/2004
Pharmacy Provider Notice #005   12/14/2004
Pharmacy Provider Notice #004   12/09/2004
Pharmacy Provider Notice #003   12/09/2004
Pharmacy Provider Notice #002   11/15/2004

PIDL

Drug Information
Item Last Modified
Physician Injectable Drug List (PIDL) External URL
Billing Instructions
Item Last Modified
Billing Instructions External URL
Education
Item Last Modified
Physician Injectable Drug List Tutorial 06/30/2015
Physician Injectable Drug List FAQs 06/30/2015
Provider Notices
Title Last Modified
Department for Medicaid Services External URL
Additional Resources
Title Last Modified
For a list of J Code to NDC conversion factors please refer to the following website: External URL
For a list of HCPCS codes please refer to the following website: External URL
For a list of participating labelers please refer to the CMS maintained list on the following website: External URL
Contacts
Resource Contact
For questions regarding the submission of a claim, procedure code(s), remittance advice, and/or payment, please contact a HP (formerly EDS) Provider Representative at: (800) 807-1232
If you have questions relating to rebates for physician administered drugs or NDC numbers, please contact Magellan Medicaid Administration, Inc. at: (314) 387-4793
Title Last Modified
Universal PA Request Form – All Others 01/03/2017
Universal PA Request Form – Buprenorphine 01/03/2017

For telephonic prior authorization requests or inquiries regarding a prior authorization please call (800) 477-3071.

Please fax prior authorization requests to one of the following numbers —

Regular Fax Line:
800-365-8835
Urgent Requests:
800-421-9064
Nursing Facility:
800-453-2273
Mental Health Drugs:
800-453-2273
Denials and Appeals
  • Only a patient or family member can appeal a prior authorization denial
  • The member has 30 days from receipt of the denial letter to submit a written appeal to the address below:
    • Kentucky Department for Medicaid Services
      Division of Administration and Financial Management
      Administrative Services Branch, 6W-C
      275 East Main Street
      Frankfort, KY 40621-0001
  • The prescribing physician can attend the appeal hearing and testify on the patient’s behalf
Pharmacy and Therapeutics Advisory Committee
Item Last Modified
Information about the Pharmacy and Therapeutics Advisory Committee External URL
Forms
Item Last Modified
P & T Speaker Request Form - PDF 12/04/2015
P & T Speaker Request Form – Word 12/04/2015
This Year’s Meetings
September 21, 2017 Last Modified
Agenda 09/12/2017
Options 09/12/2017
May 18, 2017 Last Modified
Agenda 04/28/2017
Options 04/28/2017
March 16, 2017 Last Modified
Agenda 03/16/2017
Options 03/16/2017
Previous Year’s Meetings
November 17, 2016 Last Modified
Agenda 11/04/2016
Options 11/04/2016
September 15, 2016 Last Modified
Agenda 08/23/2016
Options 08/23/2016
May 19, 2016 Last Modified
Agenda 05/10/2016
Options 05/10/2016
March 17, 2016 Last Modified
Agenda 03/04/2016
Options 03/04/2016
Committee Recommendations from from March 17, 2016 01/11/2017
Commissioner’s Final Decisions from March 17, 2016 01/11/2017
January 21, 2016 Last Modified
Agenda 01/21/2016
Options 01/21/2016
Committee Recommendations from from January 21, 2016 01/11/2017
Commissioner’s Final Decisions from January 21, 2016 01/11/2017
November 19, 2015 Last Modified
Agenda 05/10/2016
Options 05/10/2016
Commissioner’s Final Decisions from November 19, 2015 05/10/2016
Cancelled due to lack of quorum N/A
September 17, 2015 Last Modified
Agenda 08/28/2015
Options 08/28/2015
Commissioner’s Final Decisions from September 17, 2015 01/06/2016
Cancelled due to lack of quorum N/A
July 16, 2015 Last Modified
Agenda 06/30/2015
Options 06/30/2015
Commissioner’s Final Decisions from July 16, 2015 09/16/2015
May 21, 2015 Last Modified
Agenda 05/05/2015
Options 05/05/2015
Commissioner’s Final Decisions from May 21, 2015 07/28/2015
Cancelled due to lack of quorum N/A
March 19, 2015 Last Modified
Commissioner’s Final Decisions from March 19, 2015 04/21/2015
Cancelled due to lack of quorum N/A
January 15, 2015 Last Modified
Commissioner’s Final Decisions from January 15, 2015 02/25/2015
Cancelled due to lack of quorum N/A
Member List
Title Last Modified
P & T Member List 05/10/2016
Directions
Title Last Modified
Capitol Annex Directions 06/09/2014
Frankfort, KY Map 04/26/2010
Pharmacy and Therapeutics Advisory Committee Archives
November 19, 2015 Last Modified
Agenda 05/10/2016
Options 05/10/2016
Commissioner’s Final Decisions from November 19, 2015 05/10/2016
Cancelled due to lack of quorum N/A
September 17, 2015 Last Modified
Agenda 08/28/2015
Options 08/28/2015
Commissioner’s Final Decisions from September 17, 2015 01/06/2016
Cancelled due to lack of quorum N/A
July 16, 2015 Last Modified
Agenda 06/30/2015
Options 06/30/2015
Commissioner’s Final Decisions from July 16, 2015 09/16/2015
May 21, 2015 Last Modified
Agenda 05/05/2015
Options 05/05/2015
Commissioner’s Final Decisions from May 21, 2015 07/28/2015
Cancelled due to lack of quorum N/A
March 19, 2015 Last Modified
Commissioner’s Final Decisions from March 19, 2015 04/21/2015
Cancelled due to lack of quorum N/A
January 15, 2015 Last Modified
Commissioner’s Final Decisions from January 15, 2015 02/25/2015
Cancelled due to lack of quorum N/A
November 20, 2014 Last Modified
Agenda 11/06/2014
Options 11/06/2014
Commissioner’s Final Decisions from November 20, 2014 12/16/2014
Cancelled due to lack of quorum N/A
September 18, 2014 Last Modified
Agenda 09/18/2014
Options 09/18/2014
Commissioner’s Final Decisions from September 18, 2014 10/20/2014
Cancelled due to lack of quorum N/A
July 17, 2014 Last Modified
Agenda 07/17/2014
Options 07/17/2014
Cancelled due to lack of quorum N/A
May 15, 2014 Last Modified
Cancelled due to lack of quorum N/A
March 20, 2014 Last Modified
Agenda 02/28/2014
Options 02/28/2014
Committee Recommendations 03/26/2014
Commissioner’s Final Decisions from March 20, 2014 03/26/2014
January 16, 2014 Last Modified
Cancelled due to lack of quorum N/A
November 21, 2013 Last Modified
Agenda 10/31/2013
Options 10/31/2013
Committee Recommendations 11/27/2013
Commissioner’s Final Decisions from November 21, 2013 02/03/2014
September 19, 2013 Last Modified
Agenda 08/30/2013
Options 08/30/2013
Committee Recommendations 09/23/2013
Commissioner’s Final Decisions from September 19, 2013 12/10/2013
July 18, 2013 Last Modified
Cancelled due to lack of quorum N/A
May 16, 2013 Last Modified
Cancelled due to lack of quorum N/A
March 21, 2013 Last Modified
Agenda 03/05/2013
Options 03/11/2013
Committee Recommendations 03/27/2013
Commissioner’s Final Decisions from March 21, 2013 07/05/2013
January 17, 2013 Last Modified
Agenda 12/27/2012
Options 12/27/2012
Cancelled due to lack of quorum N/A
November 15, 2012 Last Modified
Agenda 10/30/2012
Options 10/30/2012
Committee Recommendations 11/21/2012
Commisioner's Final Decisions from November 15, 2012 01/08/2013
September 20, 2012 Last Modified
Cancelled due to lack of quorum N/A
July 19, 2012 Last Modified
Agenda 06/27/2012
Options 06/27/2012
Committee Recommendations 07/24/2012
Commisioner's Final Decisions from July 19, 2012 08/20/2012
May 17, 2012 Last Modified
Cancelled due to lack of quorum N/A
March 15, 2012 Last Modified
Agenda 02/27/2012
Options 02/27/2012
Committee Recommendations 03/20/2012
Secretary's Final Decisions from March 15, 2012 04/24/2012
January 19, 2012 Last Modified
Agenda 01/05/2012
Options 01/05/2012
Cancelled due to lack of quorum N/A
November 17, 2011 Last Modified
Cancelled due to lack of quorum N/A
Agenda 11/02/2011
Options 11/02/2011
September 15, 2011 Last Modified
Cancelled due to lack of quorum N/A
Agenda 08/30/2011
Options 08/30/2011
July 21, 2011 Last Modified
Agenda 07/06/2011
Options 07/06/2011
Committee Recommendations 07/25/2011
Secretary's Final Decisions from July 21, 2011 08/26/2011
May 19, 2011 Last Modified
Agenda 05/02/2011
Options 05/02/2011
Committee Recommendations 05/24/2011
Secretary's Final Decisions from May 19, 2011 06/27/2011
March 17, 2011 Last Modified
Agenda 02/28/2011
Options 02/28/2011
Committee Recommendations 03/23/2011
Secretary's Final Decisions from March 17, 2011 04/26/2011
January 20, 2011 Last Modified
Cancelled due to lack of quorum N/A
Agenda 01/05/2011
Options 01/05/2011
November 18, 2010 Last Modified
Agenda 11/01/2010
Options 11/01/2010
Committee Recommendations 11/24/2010
Secretary's Final Decisions from November 18, 2010 01/05/2011
September 16, 2010 Last Modified
Agenda 09/01/2010
Options 09/01/2010
Committee Recommendations 09/22/2010
Secretary's Final Decisions from September 16, 2010 10/28/2010
Speaker Request Form 09/01/2010
July 15, 2010 Last Modified
Cancelled due to lack of quorum N/A
Agenda 06/28/2010
Options 06/28/2010
May 20, 2010 Last Modified
Agenda 05/05/2010
Options 05/05/2010
Committee Recommendations 05/27/2010
Secretary's Final Decisions from May 20, 2010 06/28/2010
Speaker Request Form 05/05/2010
March 18, 2010 Last Modified
Agenda 03/03/2010
Options 03/03/2010
Committee Recommendations 03/24/2010
Secretary's Final Decisions from March 18, 2010 05/19/2010
Speaker Request Form 03/03/2010

Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Information

Magellan Medicaid Administration has provided a website to satisfy the CAQH Committee Operating Rules for Information Exchange (CORE) mandate requiring online capability for both Electronic Fund Transfer (EFT) and Electronic Remittance Advice (ERA) enrollment. Both forms can be completed and electronically submitted via the web portal at https://eftera.magellanrx.com.

Additionally, paper Electronic Fund Transfer (EFT) and Electronic Remittance Advice (ERA) enrollment forms have been revised in order to satisfy the CAQH Committee Operating Rules.

Electronic Funds Transfer (EFT)

To submit a request to receive an Electronic Funds Transfer (EFT) via the website go to https://eftera.magellanrx.com.
Electronic Funds Transfer (EFT) Help Document with Instructions

If you prefer to submit a paper request to receive an Electronic Funds Transfer (EFT) you can access the form and instructions here — EFT Paper Form (with Instructions & FAQ).

Note: If you would like to receive a paper check please contact Pharmacy Networks Services at 800-441-6001.

Electronic Remittance Advice (ERA)

To submit a request to receive an Electronic Remittance Advice (ERA) via the website go to https://eftera.magellanrx.com.
Electronic Remittance Advice (ERA) Help Document with Instructions

If you prefer to submit a paper form to receive an Electronic Remittance Advice (ERA) you can access the form and instructions here — ERA Paper Form (with Instructions & FAQ).

Note: If you would like to receive a paper Remittance Advice please contact Pharmacy Networks Services at 800-441-6001.

2013 Seminars

No seminars held in 2013.

2012 Seminars

No seminars held in 2012.

2011 Seminars
Seminar Information

Please refer to this link for the Spring 2011 seminar information. The RSVP regional letter, seminar directions, and presentation information are located on this website.

Title Last Modified
Pharmacy Spring 2011 Presentation 03/28/2011
Seminar Schedule
Region & Date Location
Southeastern Kentucky - April 5, 2011 Williamsburg Tourist and Convention Center
650 South 10th Street, Williamsburg, KY 40769
1:30 PM - 3:30 PM - Session C
Southeastern Kentucky - April 6, 2011 Williamsburg Tourist and Convention Center
650 South 10th Street, Williamsburg, KY 40769
9:00 AM - 11:00 AM - Session E
1:30 PM - 3:30 PM - Session H
Southwestern Kentucky - April 14, 2011 Kentucky Dam State Park Convention Center
113 Administration Drive, Gilbertsville, KY 42044
1:30 PM - 3:30 PM - Session C
Southwestern Kentucky - April 15, 2011 Kentucky Dam State Park Convention Center
113 Administration Drive, Gilbertsville, KY 42044
9:00 AM - 11:00 AM - Session E
1:30 PM - 3:30 PM - Session H
Central Kentucky - April 19, 2011 Four Points by Sheraton Lexington
1938 Stanton Way, Lexington, KY 40511
1:30 PM - 3:30 PM - Session C
Central Kentucky - April 20, 2011 Four Points by Sheraton Lexington
1938 Stanton Way, Lexington, KY 40511
9:00 AM - 11:00 AM - Session E
1:30 PM - 3:30 PM - Session H
Southern Kentucky - April 27, 2011 Holiday Inn University Plaza
1021 Wilkinson Trace, Bowling Green, KY 42103
1:30 PM - 3:30 PM - Session C
Southern Kentucky - April 28, 2011 Holiday Inn University Plaza
1021 Wilkinson Trace, Bowling Green, KY 42103
9:00 AM - 11:00 AM - Session E
1:30 PM - 3:30 PM - Session H
Eastern Kentucky - May 4, 2011 Jenny Wiley State Park Convention Center
75 Theatre Court, Prestonsburg, KY 41653
1:30 PM - 3:30 PM - Session C
Eastern Kentucky - May 5, 2011 Jenny Wiley State Park Convention Center
75 Theatre Court, Prestonsburg, KY 41653
9:00 AM - 11:00 AM - Session E
1:30 PM - 3:30 PM - Session H
Western Kentucky - May 10, 2011 Ramada Plaza
9700 Bluegrass Parkway, Louisville, KY 40299
1:30 PM - 3:30 PM - Session C
Western Kentucky - May 11, 2011 Ramada Plaza
9700 Bluegrass Parkway, Louisville, KY 40299
9:00 AM - 11:00 AM - Session E
1:30 PM - 3:30 PM - Session H
Northern Kentucky - May 24, 2011 Drawbridge Inn
2744 Royal Drive, Fort Mitchell, KY 41017
1:30 PM - 3:30 PM - Session C
Northern Kentucky - May 25, 2011 Drawbridge Inn
2744 Royal Drive, Fort Mitchell, KY 41017
9:00 AM - 11:00 AM - Session E
1:30 PM - 3:30 PM - Session H
2010 Seminars
Seminar Invite
Title Last Modified
Summer 2010 Pharmacy Seminar Invite 07/30/2010
Seminar Registration
Title Last Modified
Summer 2010 Pharmacy Seminar Registration Form 07/29/2010
Seminar Presentations
Title Last Modified
Summer 2010 Pharmacy Presentation 02/02/2011
Seminar Schedule
Region & Date Location
Western Kentucky - August 27, 2010 Murray State — Paducah Campus
3000 Irvin Cobb Dr, Room 112
Paducah, KY 42001
Eastern Kentucky - August 31, 2010 Jenny Wiley State Park
Wilkinson Stumbo Convention Center
75 Theater Court, Cherokee Room
Prestonsburg, KY 41653
Central Kentucky - September 2, 2010 Kentucky Transportation Cabinet Office Building
Conference Center, Room 117
20 Mero Street
Frankfort, KY 40622
Southern Kentucky - September 8, 2010 Cave City Convention Center
502 Mammoth Cave Street, West Hall A
Cave City, KY 42127
Northern Kentucky - September 14, 2010 Boone County Library
7425 U.S. 42
Florence, KY 41042
For questions regarding the webinar(s) listed below please contact Michael Price at Mprice@Magellanhealth.com.
Presentations
Title Last Modified
Kentucky Medicaid Pharmacy 3Q2012 Webinar 11/02/2012
Kentucky Medicaid Pharmacy 1Q2011 Webinar 03/30/2011