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 | Pharmacy-Notification-of-Other-Insurance-Coverage.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 | |
| Pharmacy Reconsideration Request Form | Pharmacy-Reconsideration-Request-Form.pdf | May 26, 2017 3:23 pm |
DOM Lists
- 90 Day Maintenance List – disease state format effective April 1, 2012
- 90 Day Maintenance List – effective April 1, 2012
- 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
- Mississippi Medicaid Covered OTC NDC List
- DESI drug list 2010
- Inhaled meds max units list
- Products with quantity limits – effective July 1, 2010
- Family Planning Waiver Drugs Covered through Point of Sale (POS) – effective Jan. 1, 2015
Miscellaneous
- Family planning waiver renewal changes
- Buprenorphine/Naloxone and Buprenorphine coverage summary for providers
- Carisoprodol tapering
- Stimulants – Approved Indications Coverage
Billing and Claims
- 72-hour emergency Rx supply billing directions
- 72-hour emergency prescription
- 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
- Medicaid pharmacy plan – BIN & PCN
- Mississippi NCPDP D.0 Payor Sheet 2013
- ICD-10 codes for POS claims and Smart PAs
Other
- Mississippi Medicaid pharmacy contact and billing information
- Pharmacy Medicare and Medicaid relationship
- Tamper resistant prescription pad information
