Welcome, Providers!

Pharmacy Medication Guidance

• 90-day Supplies:
• Medicaid covers a 90-day supply for most prescription and over the counter (OTC) maintenance medications
           Please note, prior authorization may be required for 90-day supplies of some medications.
• Where practicable, practitioners and pharmacists may utilize 90-day supplies of long-term maintenance medications for individuals in quarantine or those that have been identified by the CDC as being at a higher risk for developing serious illness from COVID-19.
   
• Medication Delivery:
  • Pharmacies that choose to provide delivery to individuals quarantined may confirm receipt of the medications by the member through a phone call, text or email, in lieu of getting a signature.
     
• Prescription transfers:
  • If a Medicaid member has had a prescription filled from a pharmacy that is inaccessible or to that pharmacy is not feasible, then he/she can obtain a new prescription/fiscal traveling order from the prescriber; OR
  • A refill of the prescription can be transferred to another Medicaid participating pharmacy (where allowed by law).

For Retail Pharmacies: Refill Too Soon Rejection Overrides

“Refill Too Soon” edits are available for pharmacies to utilize in order to provide early refills to members in response to emergencies.

Pharmacy Claim Submission Information

When a claim submission results in a “refill too soon” rejection, pharmacies may enter the following information to re-process the claim:

Covered Lines of Business

• Medicaid (Medicaid Managed Care, Child Health Plus, and HealthierLife)
• Essential Plan
• Health Benefit Exchange (Metal Level Products)
• Medicare Part D

Contact Numbers

• CVS Help Desk, Medicaid and Commercial Plans: 1-800-364-6331
• CVS Help Desk, Medicare Part D: 1-866-693-4620
• Fidelis Care Help Desk: 1-888-FIDELIS