Below are resources and links for pharmacy services.
Pharmacy Forms
| Title | File Name | Caption | Date |
|---|---|---|---|
| DOMPriorAuthorizationInstructions | DOMPriorAuthorizationInstructions.pdf | April 8, 2014 8:31 pm | |
| MedWatch Form | MedWatch-Form.pdf | April 8, 2014 8:47 pm | |
| Pharmacy Notification of Other Insurance Coverage | Pharmacy-Notification-of-Other-Insurance-Coverage.pdf | April 8, 2014 8:48 pm | |
| Pharmacy Appeal/Reconsideration Form Request | PharmacyAppealReconsiderationRequestForm.pdf | April 8, 2014 8:48 pm | |
| Synagis Season 2012-2013 in Mississippi | Synagis-2010-2011-PA-Criteria.pdf | April 8, 2014 8:48 pm | |
| Crossover Form B | CrossoverFormB.pdf | April 8, 2014 8:48 pm | |
| Pharmacy Claim Form and Form Instructions | MedicaidTitleXIXPharmacyInvoice.pdf | April 8, 2014 8:48 pm | |
| PriorAuthorizationForm | PriorAuthorizationForm.pdf | December 18, 2014 8:02 pm | |
| Synagis PA criteria 2015-2016 | 2015-2016-synagis-criteria.pdf | September 10, 2015 6:33 pm | |
| Antipsychotics Manual PA form | Antipsychotics-Manual-PA-form.pdf | August 29, 2016 12:58 pm |
90-Day Maintenance Lists
- 90 Day Maintenance List – effective July 1, 2009 – March 31, 2012
- 90 Day Maintenance List – disease state format
- 90 Day Maintenance List – effective April 1, 2012
Over-the-Counter Drug Lists
- Current over-the-counter (OTC) drug list
- Mississippi Medicaid Covered OTC NDC List
- OTC drug list – effective March 12 – Sept. 30, 2013
- OTC drug list – effective Jan. 1 – March 11, 2013
- OTC drug list – effective Sept. 1, 2011 – Dec. 31, 2012
- OTC drug list – effective July 1, 2010
- OTC drug list – effective Jan. 1, 2009
- OTC drug list – effective July 1, 2008
Specific Drugs
- Family planning waiver renewal changes
- 72-hour emergency prescription
- Abilify information
- Buprenorphine/Naloxone and Buprenophine coverage summary for providers
- Buprenorphine/Naloxone and Buprenophine patient information
- Carisoprodol tapering
- Cough and cold quick list – Sept. 2015
- Cough and cold quick list – Nov. 2011
- DESI drug list 2010
- Federal upper limit drugs – transmittal #37, Nov. 20, 2001
- Federal upper limit drugs – transmittal #37 changes Sept. 25, 2009
- Inhaled meds max units
- Mental health drugs pharmacy changes – Dec. 1, 2012
- Products with quantity limits – effective July 1, 2010
- Proton pump inhibitors in PEG tube quicklist
Billing and Claims
- 72-hour emergency Rx supply billing directions
- Disaster billing directions
- Billing for hospice patients
- Billing for influenza and pneumonia
- Billing other insurance instructions
- Correct date of birth on pharmacy claims
- Flat rate price of generics being offered in Mississippi
- Medicaid pharmacy plan – bank information no. and processor control no.
- Mississippi NCPDP D.0 Payor Sheet 2013
- Pharmacy reimbursement
- ICD-10 codes for POS claims and Smart PAs
- ICD-9 information for treatment of cystic fibrosis
- Pharmacy Provider reminder, ICD9 code requirement
Other
- Mississippi Medicaid pharmacy contact and billing information
- Pharmacy Medicare and Medicaid relationship
- Pharmacy news and notices archive
- Pharmacy survey letter – July 2012
- Pharmacy survey reminder letter – July 2012
- Tamper resistant prescription pad information
- Pharmacy Stakeholder meeting presentation – March 2016
- Pharmacy Stakeholder meeting presentation – May 2016
