Below are resources and links for pharmacy services.
Pharmacy Forms
| Title | File Name | Caption | Date |
|---|---|---|---|
| MedWatch Form | MedWatch-Form.pdf | April 8, 2014 8:47 pm | |
| 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 | |
| Pharmacy Claim Form and Form Instructions | MedicaidTitleXIXPharmacyInvoice.pdf | April 8, 2014 8:48 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): effective July 1, 2018
- Cough and cold quick list – Sept. 2015
- Current over-the-counter (OTC) drug list
- Family Planning Waiver Drugs Covered through Point of Sale (POS) – effective Jan. 1, 2015
- Insulin products with quantity limits – effective January 2019
- Mississippi Medicaid Covered OTC NDC List
- Oral Inhalers / Nebulizer Solution Quantity Limits List – effective August 2019
- Specialty Drug List
Miscellaneous
Billing and Claims
- 72-hour emergency Rx supply billing directions – effective Sept. 28, 2018
- 72-hour emergency prescription – effective Nov. 1, 2019
- Governor declared disaster – Rx billing directions
- Hospice patients billing
- Influenza and pneumonia billing
- Other insurance billing instructions
- Flat rate price of generics being offered in Mississippi
- MS Medicaid pharmacy contact and billing information (PCN/BIN) – eff. Nov. 1, 2019
- Mississippi NCPDP D.0 Payer Sheet 2019
- ICD-10 codes for POS claims and Smart PAs
