Below are resources and links for pharmacy services.
Pharmacy Forms
| Title | File Name | Caption | Date |
|---|---|---|---|
| Pharmacy-Notification-of-Other-Insurance-Coverage.pdf | Pharmacy-Notification-of-Other-Insurance-Coverage.pdf | August 15, 2019 4:23 pm | |
| Crossover Form B | CrossoverFormB.pdf | April 8, 2014 8:48 pm | |
| MedWatch Form | MedWatch-Form.pdf | June 27, 2024 8:59 pm |
DOM Lists
- 90-Day Maintenance List – disease state format effective April 1, 2019
- 90-Day Maintenance List – effective April 1, 2019
- Clinician Administered Drugs and Implantable Drug System Devices (CADD)
- Covered Over-The-Counter (OTC) Drug List
- Covered Over-The-Counter (OTC) NDC List
- Family Planning Waiver Drugs Covered through Point of Sale (POS) – effective August 2, 2023
- Insulin and Diabetic Products with Quantity Limits – effective February 2019 (updated July 2024)
- MS Medicaid Vaccines Covered Through Pharmacy Billing
- Oral Inhalers / Nebulizer Solution Quantity Limits List – effective August 2019 (updated Nov. 2020)
- Prenatal Vitamins NDC List – effective January 1, 2022 (updated August 1, 2024)
- Specialty Drug List (archived)
Miscellaneous
- Buprenorphine/Naloxone and Buprenorphine Therapy Guidance – Provider Summary – revised January 2023
- Family planning waiver renewal changes
- Stimulants – Approved Indications Coverage
Billing and Claims
- 72-hour emergency Rx supply billing directions – effective July 1, 2024
- Governor declared disaster – Rx billing directions
- Hospice patients billing
- Other insurance billing instructions / cost avoidance
- MS Medicaid pharmacy contact and billing information (PCN/BIN) – eff. July 1, 2024
- Mississippi NCPDP D.0 Payer Sheet 2022
- ICD-10 codes for POS claims and Smart PAs – eff. Sept. 23, 2021
