Pharmacy Archive

COVID-19 Updates for Alabama Medicaid Pharmacy Providers

• See Pharmacy ALERT for COVID-19 Unwinding - Changes to Pharmacy/DME at this link: https://medicaid.alabama.gov/alert_detail.aspx?ID=16117 - 4/21/2023
• See Pharmacy ALERT for COVID-19 Prescribing of Paxlovid by Pharmacists at this link: https://medicaid.alabama.gov/alert_detail.aspx?ID=15984- 10/12/2022
• See Pharmacy ALERT for COVID-19 OTC and "At Home" Tests for Pharmacy Billing at this link: https://medicaid.alabama.gov/alert_detail.aspx?ID=15725 - 1/20/22

• See Pharmacy ALERT for Pharmacy Updates Related to COVID-19 at this link: https://medicaid.alabama.gov/alert_detail.aspx?ID=15435 - 4/14/2021

• See Pharmacy ALERT for COVID-19 Vaccine Information for Pharmacy Billing at this link: https://medicaid.alabama.gov/alert_detail.aspx?ID=15389 - 3/18/2021

• See Pharmacy ALERT at this link: https://medicaid.alabama.gov/alert_detail.aspx?ID=13747 - 3/19/20 See Pharmacy ALERT for COVID-19 vaccine billing at this link: https://medicaid.alabama.gov/alert_detail.aspx?ID=14255 -12/29/20
• PDL Update: In response to the COVID-19 pandemic and reported shortages in certain areas of our state, all covered NDCs of albuterol inhaler (brand and generic) are now included/listed as preferred in the Preferred Drug List. Prior Authorization is not required; maximum unit edits still apply. Effective 3/19/20
• Lifted the Accumulation Edit - Effective 3/19/20
• Updated signature requirements during the state of emergency See ALERT here - Effective 3/16/20
• Implemented a universal prior authorization (PA) number (9999999999) to override the following edits/limitations:
  • Early Refill - conflict/intervention/outcome codes are still required - Effective 3/23/20
  • Maximum Units - Effective 3/23/20
  • Mandatory Three Month Maintenance Supply - Effective 3/23/20
• Delayed the implementation of the next MME decrease schedule for April 1, 2020
• Allowance for approval of 30 day extensions of existing PAs to be made verbally without additional documentation - Effective 3/23/20
• Discontinuation of audits during the state of emergency

Opioid Edits

On May 1, 2019, the Alabama Medicaid Agency implemented a "Cumulative MME Edit" for opioid-experienced recipients.

• See ALERT at this link: https://www.medicaid.alabama.gov/alert_detail.aspx?ID=13378.
• Override Form and Criteria can be found at the following link when it is available (no criteria needed during phase-in period):  Pharmacy Forms and Criteria
• Prescribers and Pharmacists click here for the printable Recipient Information Sheet (scroll to bottom of page)
• HHS Guidance for Dosage Reduction or Discontinuation of Opioids

On November 1, 2018, the Alabama Medicaid Agency implemented limits on short-acting opiates for opioid naïve recipients.

• See ALERT at this link: http://medicaid.alabama.gov/alert_detail.aspx?ID=12978.
• Override Form and Criteria can be found at the following link:  Pharmacy Forms and Criteria
• Prescribers and Pharmacists click here for the printable Recipient Information Sheet (scroll to bottom of page)