Preferred Brand Drugs with federal upper limits

The Mississippi Division of Medicaid has implemented a systematic fix for preferred brand drugs listed on the preferred drug list (PDL), which have been reimbursing with an ingredient cost based on the federal upper limits (FUL) price impacting fee-for-service Medicaid.

Pharmacists may enter a DAW of ‘9’  on claims to override the FUL price on preferred brand drugs found on the PDL. This fix is retroactive for claims with a Date of Service of 4/11/2016 and forward. Claims which paid incorrectly should be reversed and resubmitted with the original date of service (fill date).

For Magnolia Heath or UnitedHealthcare Community Plan, contact their Help Desk for an override.