Topics Related to Pharmacy Providers

Ventolin® HFA will shift from Non-Preferred to Preferred on the Preferred Drug List (PDL), effective Sept. 23, 2022.
The PDAP Medicaid fee schedule requires multiple rate updates
Pharmacy Point of Sale claims for members enrolled Tailored Plans will be managed by NCTracks when Tailored Plans launch through March 31, 2023.
Edits are scheduled to resume on July 1, 2022
Effective May 1, 2022, claims with Rev Code 025x and 063x will deny without appropriate documentation of NDC and HCPCS codes.
Effective Feb. 1, 2022, Clinical Pharmacist Practitioner taxonomy code 1835P0018X will be allowed to bill and be reimbursed.
Certain immunocompromised children will qualify for third dose of Pfizer-BioN Tech Vaccine
Oral tablets covered for those in a home setting