Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.17-006 - Pharmacy 1-17

Current through Register Vol. 49, No. 6, June, 2024
210.000
PROGRAM COVERAGE
211.000
Scope
The Arkansas Medicaid Pharmacy Program conforms to the Medicaid
				Prudent Pharmaceutical Purchasing Program (MPPPP) that was enacted as part of
				the Omnibus Budget Reconciliation Act (OBRA) of 1990.
This law requires
				Medicaid to limit coverage to drugs manufactured by pharmaceutical companies
				that have signed rebate agreements.
A numeric listing of approved
				pharmaceutical companies and their respective labeler codes is located on the
				Arkansas Division of Medical Services (DMS) Pharmacy website at
https://arkansas.magellanrx.com/provider/documents/
.
View or print numeric listing of approved pharmaceutical companies
				and their respective labeler codes.
Except for drugs in the
				categories excluded from coverage, Arkansas Medicaid covers all drug products
				manufactured by companies with listed labeler codes. Additions or deletions by
				labelers are submitted to the State by the Centers for Medicare and Medicaid
				Services (CMS), the website will be updated.
The Arkansas Medicaid Program will cover the following drug
				categories:
A. Prescription drugs are
			 covered by the Arkansas Medicaid Program pursuant to an order from an
			 authorized prescriber. The Drug Listing located on the DMS Pharmacy website at
https://arkansas.magellanrx.com/provider/documents/
lists
			 those products covered by the Arkansas Medicaid Program that have a State
			 Actual Acquisition Cost (SAAC).
As changes are made to the drug coverage, providers will be
				notified of the revisions.
B. Over-the-counter items are listed on the
			 website at https://arkansas.maqellanrx.com/provider/documents/
.
These items are covered only if they contain an appropriate National
			 Drug Code on their label and are manufactured by a company that has signed a
			 rebate agreement. Over-the-counter items are not covered for long-term care
			 facility residents.
View or print a list of over-the-counter
			 items.
The Arkansas Medicaid Program will reimburse pharmacies the
				cost and administration fee for selected vaccines for Medicaid beneficiaries
				age 19 and older. For a complete list of covered vaccines and CMS-1500 billing
				instructions, please refer to
https://arkansas.maqellanrx.com/provider/docs/rxinfo/Pharmacv%20Vaccine.pdf
.
A prescription order from an authorized prescriber must be on file;
				however, no primary care physician (PCP) referral is required to administer the
				vaccines.
These vaccines are payable for Medicaid-eligible beneficiary
				age 19 years and older. The influenza virus vaccine is limited to one per state
				fiscal year (July through June). The pneumococcal polysaccharide vaccine is
				limited to one every ten years.
The Arkansas Medicaid Program will reimburse pharmacies the
				administration fee for selected vaccines that are obtained through the Vaccine
				for Children Program (VFC) or ARKids-B SCHIP Vaccine program. Please refer to
				section 292.950 of the Physician manual for VFC vaccines billing procedures and
				section 262.430 for ARKids-B SCHIP vaccine. A prescription order from an
				authorized prescriber must be on file; however, no primary care physician (PCP)
				referral is required to administer the vaccines. All Arkansas State Board of
				Pharmacy laws and regulations will apply.
Effective 8/1/15, ARKids-B beneficiaries are no longer eligible
				for the VFC program. However, providers are still able to obtain vaccines to
				administer to ARKids-B beneficiaries by contacting the Arkansas Department of
				Health (ADH) and indicating the need to order "ARKids-B SCHIP vaccines or
				Vaccines for Children (VFC)." VFC vaccines can also still be obtained by
				contacting ADH. For dates of service on or after 8/1/15, modifier "SL" will be
				required when billing for the administration of SCHIP vaccines to ARKids-B
				beneficiaries. Modifier EBTJ is required when billing for administration of VFC
				vaccines for ARKids-A beneficiaries.
Medicaid will reimburse the Medicare deductible and/or
				coinsurance for all beneficiaries receiving both Medicare and Medicaid benefits
				in reference to vaccines.
Pharmacies must use the CMS-1500 claim form when billing
				Medicaid for these vaccines.