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**** Drug Labelers with Outstanding Balances as reported to CMS ****

FRESENIUS KABI USA, LLC   MERCK & CO. INC
NOVARTIS PHARMACEUTICALS   VALEANT PHARMACEUTICALS
    Updated on 07/28/2016
**** Tip of the Day ****

In response to Zika virus concerns, effective July 1st, 2016, select insect repellant will be covered for traditional Delaware Medicaid (Fee-for-Service) clients. A valid prescription from an authorized practitioner is required, and the products do have a per client limitation of one bottle per 30 days.

For any further clarification on this change, please contact Pharmacy Services at 1.800.999.3371 select option 0, select option 1.

Effective January 1, 2015 the Pharmacy Benefit has been included in the Managed Care Organization (MCO) package.

Highmark Health Options
Providers: 1-844-325-6253
Clients: 1-844-325-6251

UnitedHealthCare Community Plan of Delaware 1-800-842-4195

Click here to learn how to submit pharmacy prior authorizations online to expedite the process:
How to submit online prior authorizations
How to check the status of an online prior a uthorization

Click here for list of Prior Authorization Forms

Click here for list of State Non-Participating Drug Manufacturers
Click here for the DPAP Application form
*** Drug Rebate Documents ***


Click here for information on web invoicing: Delaware Web Invoicing Information

*** Please complete both documents for each labeler code when applying for Electronic Invoicing ***

Click here for the application for electronic invoicing

Click here for the current Memorandum of understanding for electronic invoicing
for claim level detail files from 2Q2015 on.

Click here for the previous Memorandum of understanding for electronic invoicing
for claim level detail files between 4Q2011 and 1Q2015.

For questions on web invoicing, email: MoveItDocumentTransfer@hpe.com

*** Current W9 ***

Click here for current W-9 for Drug Rebate

*** Contact Us ***

For any questions related to Drug Rebate, email: DEDrugRebate@hpe.com


Attention Medical and Pharmacy Providers

In preparation for Delaware Medicaid Enterprise System (DMES) POS claim submission processing system, the current claims proce ssing system for fee-for-service clients will not be available from midnight on Thursday 12/22/2016 through Wednesday 12/28/20 16. NOTE: Managed care members will NOT be affected by this outage, so if a client has Highmark Health Options or UnitedHealthcare Community Plan, this communication does not apply to them. Please help your clients plan ahead for prescriptions they will need filled between these dates by reading DMMA's guidance under Pharmacy POS Downtime Alert.

The PDL document has been updated from the September meeting.

The updated PDL is available under the PDL List link on this page. The implementation date for each drug class is listed below the category and will be January 1st, 2017 for the majority.

Please contact Pharmacy Services at 1.800.999.3371 select option 0, select option 1 for further clarification

Pharmaceutical and Therapeutics (P&T) Committee

The Pharmaceutical and Therapeutics (P&T) Committee has been established by DMMA to provide clinical leadership in the selection of preferred medications. This selection will be based on a review of the relative clinical effectiveness and cost of products within selected therapeutic classes. The program's objective is to achieve quality pharmaceutical care for recipients enrolled in the Department's Medicaid programs while providing significant state savings.

- P & T Committee Meeting -

The Delaware P&T meeting is scheduled for Thursday, September 8th, 2016.
1:30 p.m. - 6:00 p.m.

 Delaware Technical Community College
 400 Stanton - Christiana Road
 Newark, DE 19713
  Directions to Stanton Campus

*Times listed are approximations. The public portion of the meeting will start NO EARLIER then the time listed and may be subject to delays.

Please contact Pharmacy Services at 1-800-999-3371 select option 0, select option 1 for further clarification.

Categories for Review
Categories for Review are available under the P&T Agenda link on this page

Pharmacy Provider Manual
DMAC List (current)
DMAC List (proposed)
What's New
 
Prior Authorization Forms

Pharmacy General Information

Medicare Prescription Drug Coverage

Pharmacy Policy Cheat Sheet

Prescribing Provider Policy Cheat Sheet

P&T

PDL List

PDL Archives

P&T Bylaws


P&T Committee Members

P&T Meeting Minutes

P&T Meeting Agenda

Public Testimony Guidelines

Mental Health Drug Coverage

Email Address: PandTPublicTestimony

DUR

DUR Board Meeting Minutes

Email Address: DURBoardPublicTestimony
 

Back to DMAP Home Page


Pharmacy Corner


The DMAP policy for pharmacies can be found in the Pharmacy Provider Specific Policy Manual. Appendix F of the manual contains all forms required for prior authorization of medications. The manual can be accessed on the left sidebar.

The Medicaid Management Information System (MMIS) supports Retro-DUR and Pro-DUR functionality. Clinical data is used by the Delaware Drug Utilization Review (DUR) Board to evaluate trends in prescribing and utilization as well as cost savings from decreased hospitalizations and avoided expenses for inappropriate therapeutic sessions. Follow the DUR Board link on the sidebar at the left for notes from the Delaware DUR Board meetings.

Effective April 1st, 2014, DMAP pays based off the NADAC pricing methodology along with a dispensing fee except where the usual and customary is less. In the event that there is no NADAC price, the product will reimburse off the lower of DMAC or AWP minus 19% plus the dispensing fee. The DMAC list can be accessed on the left sidebar. NOTE: Several times a year, HP will provide a "draft" DMAC to preview upcoming DMAC pricing. Use caution when selecting the current DMAC.

The What's New page provides a description of the most recent changes in DMAP policy and procedures. Notification of provider alerts, Special Bulletins and provider manual changes are available through this link.


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