Historical Remittance Voucher Banner Messages

The Agency has decided to withdraw the Prior Authorization requirement for Synagis for this RSV season. A prior authorization will not be required for patients receiving this medication for the balance of the current RSV season. The Medicaid office will inform providers if this policy changes in the future.

August 11, 2005

Pharmacy providers will be permitted to continue billing insulin syringes, blood glucose test strips/meters through the pharmacy POS system until December 31, 2005. Providers that choose to use the DME format can do so starting August 1, 2005 or thereafter.

August 11, 2005

Nutritional supplement prior authorization requests approved by Medicaid Pharmacy Services prior to August 1, 2005 will continue to be paid through the pharmacy system until they expire. All requests for nutritional supplements after August 1, 2005 must be obtained through DME.

Preferred Drug List Changes
The most recent changes to the preferred drug list become effectie July 9. 2004. Please refer to the webpage for more information.

July 1, 2004

Beginning July 15, 2004, Medicaid Pharmacy Services will not approve payment for Actiq, (oral transmucosal fentanyl citrate) for any indication other than malignant pain associate with cancer. Prescribers wanting to use Actiq for breakthrough pain in their patients with cancer, may obtain it by completing the Actiq form posted on the Florida Medicaid web site.

June 24, 2004

Effective July 1, 2004 Florida Medicaid Prescribed Drug Services Program reimbursement methodology will change. Pharmacy claims will be reimbursed at the lower Average Wholesale Price (AWP) minus 15.4%, Wholesale Acquisition Price (WAC) plus 5.75%, Federal Upper Limit Price, State Maximum Allowable Price or the Usual or Customary Price.

June 18, 2004

Beginning July 1st, 2004 Medicaid Pharmacy Services will approve payment for the COX II inhibitors according to their FDA labeled indications. Because there is no diagnosis code required for these medications, the system alerts will be set using the FDA dosing for osteoarthritis as these are the more conservative dosing guidelines. The higher doses and frequency used for primary dysmenorrheal will be limited to 7 days before requiring prior authorization. Otherwise, prescribers requesting dosing for more than 7 days and more frequently than once a day for Bextra, Vioxx or Celbrex 200mg/400mg will be required to obtain a prior authorization. Existing prior authorizations for these drugs will be honored until July 1, 2004.

June 18, 2004

Effective July 1, 2004 the following plan limitations will begin on the following drugs. COX II drugs Vioxx, Bextra and Celebrex will be limited to one tablet per day, Vioxx Susp 12.5mg/5mls per day will be limited to 5mls and 25mg/5ml will be limited to 10mls per day. Erectile Dysfunction drugs will be limited to one dose per 30 days. Neurontin usage will be limited to the treatment of seizure disorders. Zyprexa and Zyprexa Zydis will be limited to one tablet per day, except for the 15mg strength of both drugs will be limited to two tablets per day. Any exceptions to these limits will require prior authorization.

April 27, 2004

Beginning June 1, 2004, Medicaid Pharmacy Services will not approve full payment for selected respiratory drugs administered by inhalation for dually eligible patients, Medicare and Medicaid. Medicaid Pharmacy Services will only reimburse for the allowable charge portion not covered by Medicare Part B. The respiratory drugs affected are all strengths of albuterol, ipratropium, isoetharine, isoproterenol and n-acetylcysteine. All new requests and requests for renewal will be handled via Medicare Part B for these dually eligible recipients. Existing prior authorizations for these respiratory drugs will be honored until June 1, 2004.

April 23, 2004

Effective May 14, 2004, in accordance with the Settlement Agreement of Hernandez vs. Medows, Medicaid Pharmacies are required to post a notice and to provide information pamphlets to Medicaid recipients when payment for a prescription is denied. The notice and pamphlets will be provided to Pharmacies by the Agency for Health Care Administration at no cost. For additional information contact Medicaid Pharmacy Services at (850) 487-4441.

April 1, 2004

Beginning April 12, Medicaid Pharmacy Services will introduce a plan limit for all brands of carisoprodol of a quantity of 360 tablets/capsules per year. This change is in response to actions taken by the Medicaid Pharmacy and Therapeutics Committee.

The Pharmacy and Therapeutics Committee has recently reviewed the sedative/hypnotic and topical antifungal drug classes. There were several changes made to the Preferred Drug List, PDL.

Beginning February 2, 2004, Ambien, zolpidem will be removed from the PDL. After this date, all new prescriptions for Ambien will require Prior Authorization as a NON-PDL medication.

Beginning February 2, 2004, all Clotrimazole/Betamethasone lotion, ointment, or cream preparations will be removed from the PDL. After this date all new prescriptions for any topical preparation of Clotrimazole/Betamethasone combination will require Prior Authorization as a NON-PDL medication.

January 2, 2003

Effective January 7, 2003, Medicaid Pharmacy Services will deny claims for the following combinations of drugs for ingredient duplication within a 30 day period: Combivir plus Trizivir, Norvir plus Kaletra, Trizivir plus Ziagen, Trizivir plus Epivir, Trizivir plus Retrovir, Combivir plus Epivir, and Combivir plus Retrovir. The combination of Tetrovir and Zerit will deny for therapeutic duplication. Over rides will be obtained by calling Medicaid Pharmacy Services at (850) 547-4441.

A 72 hour supply of medications can be dispensed under the following emergency circumstances: (1) if the therapy requires authorization (PDL and 4 brand cap), and (2) the pharmacist or prescriber determines that a delay in therapy will result in harm to the patient. The Med Cert code is 1. This will not authorize payment for a 72-hour supply of drugs that requires a clinical PA, since this is not an emergency.

The Medicaid prescriber file is now posted on this web site. You can also view the most current version of the Preferred Drug List.

September 13, 2002

Important Beneficiary Lock-in Information - Follow this link to learn more about the Florida Medicaid Beneficiary Lock-in program.

May 24, 2002

Effective July 14, 2002, coverage for One Touch Basic meters will be terminated. Coverage for other Lifescan meters and coverage for strips used with existing Basic meters will continue.

April 25, 2002

Effective May 2, 2002, the triptan class of drugs will have the following plan limits:

Non-PDL items will be limited to the following:

Frova's limits will be put into effect as soon as the FDA approved medical information is available.

April 9, 2002

In an effort to control drug diversion, the Medicaid office is implementing new requirements for the dispensing of drugs to recipients in Dade, Broward, Monroe, and Palm Beach counties. Effective April 15, 2002, all pharmacies in these counties shall be required to dispense drugs in accordance with one of the following three methodologies:

1. Remove drugs from original manufacturer's packaging and place in pharmacy vials.
   
2. Inscribe "M" on the original manufacturers' packaging with an indelible black marker. The "M" should be readily visible on the packaging and no less than one inch in size.
   
3. Remove manufacturers' seals from the original containers.
   

Thank you for your assistance and for your participation in the Medicaid program.

March 8, 2002

Coumadin and Adderall are not subject to federal upper limit or state MAC pricing. The Medicaid office encourages the dispensing of branded Coumadin and Adderall, which will be reimbursed at AWP minus 13.25% plus a $4.23 dispensing fee.

February 22, 2002

Effective March 4, 2002, the requirement for Florida Medicaid MediPass patients in AHCA Areas 3, 4, 5, and 6 to obtain diabetic supplies and drugs through Health Alliance's mail order program will be reinstated. Please refer patients to Health Alliance, 1-877-722-7394. Overrides will be allowed only in emergency cases.

Effective July 1, 2001: All claims for Oxycontin will be limited to 4 doses per day except for the Oxycontin 160 mg strength, which will be limited to 2 doses per day. Prior Authorization will be required for any doses outside these limits. The nursing home dispensing fee will be increased from $4.23 to $4.73. Nursing home recipients will no longer be exempt from the four brand limit. Exemptions will be obtained from Consultec's Physcian's Help Desk at (877) 553-7481. The existing voluntary preferred drug list (VPDL) will be expanded to function as an interim formulary. An ongoing formulary is anticipated for full implementation in mid-September. Drugs not listed on the preferred drug list will require prior authorization. Formulary drugs are not exempt from the four brand limit. Prior Authorization for EOB 701 (Refill Too Soon) and EOB 709 (Duplicate Drug Too Early) will be obtained from Consultec's Prior Authorization Help Desk at (800) 603-1714.

June 06, 2001

Effective July 1, 2000, Florida Medicaid will begin requiring the use of counterfeit-proof prescription blanks by practitioners when writing hard copy prescriptions for Medicaid patients prescriptions transmitted by other means, such as fax, electronic, or telephone, are exempt. Pharmacies can only be reimbursed for original hard copy prescriptions that have been written on the counterfeit-proof prescription blanks. More information will be available on the Consultec web site and provider bulletins.

Note: See Pharmacy Notes for more information on this RV .
Note: Consultec is now Accelerated Computer Systems (ACS)

February 19, 2001

Persons who are participating in the Prescription Assistance Program for Seniors (PAPS) Program are being issued Medicaid Gold Cards. If you verify eligibility for a Medicaid recipient and they are identified with a program code of "SLMB", please note that these recipients are not eligible for Medicaid services. Persons characterized as "SLMB" are only identified to Medicaid for crossover claims purposes and for this limited prescription assistance program.

February 9, 2001

The Medicare Prescription Discount Program, implemented July 1, 2000, is a part of the Senior Prescription Affordability Act, based on Senate Bill 940, passed during the 1999/2000 Florida legislative session. The Medicare Prescription Discount Program does not restrict the age of the eligible participants. Eligibility is based upon current Florida residency and possession and presentation of a Medicare card, regardless of age.

February 6, 2001

Effective March 1, 2001, all claims for Leukine (Sargramostim) will require prior authorization. Leukine is indicated for use following induction of chemotherapy in acute Myelogenous Leukemia, in mobilization and following transplantation of autologous peripheral blood progenitor cells in myeloid reconstitution after autologous and allogeneic bone marrow transplantation, and in bone marrow transplantation failure or engraftment delay. Please contact Medicaid Bureau of Pharmacy Services at (850) 487-4441 for authorization.

Effective March 1, 2001, all claims for Myobloc (Botulinum Toxin Type B) will require prior authorization. Myobloc is indicated for the treatment of patients with cervical dystonia (CD) to reduce the severity of abnormal head position and neck pain associated with cervical dystonia. Please contact Bureau of Pharmacy Services at (850) 487-4441 for authorization.

January 18, 2001

Pharmaceutical Expense Assistance for Low-Income Individuals will be implemented January 1, 2001. Monthly benefits are limited to $80 with a mandatory 10 percent copay for each prescription. Generic substitution is required. More information to be provided through notice to all providers.

All claim denials for EOB 650, 4 Brand Limit Exceeded are handled by Consultec’s Therapeutic Consultation Program (TCP) Help Desk. Authorization for exceptions are obtained by calling 1-877-553-7481 Monday through Friday 8AM to 8PM and Saturday 10AM to 4PM. Prior to calling the TCP Help Desk, a claim must be submitted via point of sale and a denial code of 650 received by the pharmacy.

Pharmaceutical Expense Assistance for Low Income Elderly Individuals will be implemented January 1, 2001. Monthly benefits are limited to $80 with a mandatory 10 percent co-pay for each prescription. Generic substitution is required. More information will be provided through notices to all providers.

October 10, 2000

Effective November 1, 2000, Consultec will no longer accept the old FMED Pharmacy claim format. All submitters will be required to send the NCPDP format beginning 11/01/2000. The NCPDP specifications are available on Consultec’s Florida Medicaid website at http://www.floridamedicaid.consultec-inc.com. Please direct your vendor or billing agent to contact an EDI analyst for any coding or testing questions.

August 31, 2000

Effective October 1, 2000, Medicaid will provide Lifescan test meters and blood glucose test strips for Medicaid diabetic recipients that currently have no meter or a different brand of meter. All four Lifescan test strips and the two meter choices, One Touch Fasttake and One Touch Surestep, are available. Effective November 1, 2000, claims for test strips other than Lifescan will be denied. Other brands of test strips can be authorized only for necessary cases

August 14, 2000

Effective September 18, 2000 the override capability for EOB 701(Refill Too Soon) and the EOB 709 (Duplicate Drug Too Early) will be turned off. These codes will post a denial of the claim and cannot be overridden using the previous intervention, conflict, and outcome codes.

August 1, 2000

Effective August 21, 2000 all claims for Procrit and Neupogen will require prior authorization. The use of these products will be limited to their FDA approved indications. Please contact Bureau of Pharmacy Services at (850) 487-4441 for authorization.

July 14, 2000

On August 1, 2000, the 4 Brand Limit will be in effect. The exceptions will be generic drugs, insulin and diabetic supplies, contraceptives, mental health drugs and anti-retroviral drugs used for treating HIV.

Prescribers may call the toll free Consultec number to justify exceptions to the brand-name drug restriction. The number is (877) 553-7481. This number will be open Monday through Friday from 8am to 8pm, Saturday from 10am to 4pm and closed on Sundays.

Pharmacies may be paid the reimbursement cost only for a 72-hour emergency supply.

June 22, 2000

Effective July 1, 2000 all claims for Prilosec 20mg will be reimbursed by Florida Medicaid Prescribed Drug Program. Prior authorization will no longer be required for Prilosec 20mg. Medicaid will continue to reimburse for Prilosec 10mg and

40 mg. Quantity limits will be re-instated for the 10mg in mid-July.

May 2, 2000

Effective June 1 all claims for Targretin (bexarotene) will require prior authorization. Targretin is an orphan drug indicated for the treatment of cutaneous T-Cell Lymphoma (CTCL) in patients who are refractory to a least one prior systemic therapy.

March 6, 2000

Pharmacy providers are reminded that the use of certification codes are for specific situations only. Cert Code “6” should only be used on a claim for contraceptives, or prenatal vitamins for pregnant or post-partum recipients. Cert Code “8” should only be used on a claim for phosphate binders or multivitamins for patients undergoing dialysis. Any other use of these Cert Codes to get claims paid, e.g., dispensing prenatal vitamins to a male, is a false claim and will be considered Medicaid fraud. See page 6-27 and 9-5 of the Provider Handbook for more information.

March 10, 2000

Effective April 1, 2000, all claims for Cytogam® (Cytomegalovirus Immune Globulin Intravenous (Human)) will require prior authorization. Cytogam is indicated for the prophylaxis of cytomegalovirus disease associated with transplantation of kidney, lung, liver, pancreas and heart organs from cytomegalous seropositive donors to seronegative recipients.

Effective January 16, 2000, a new cost containment policy will be in effect. Medicaid will deny claims for Prilosec 20mg and will permit two 10mg capsules to achieve this dosage.

Claims for Paxil 10mg will be denied. To achieve a 10mg dose, used one-half tablet of the 20mg Paxil scored tablet.

Prior authorizations for Serostim will be approved for a length of 12 weeks. After the completion of these 12 weeks, an observation period of 8 weeks must be observed before additional therapy can be approved.

December 10, 1999

Epogen®, Amgen’s brand of epoetin alpha, is now covered by Medicaid’s freestanding dialysis center program and must be billed by a dialysis center provider using a “Q” procedure code. Beginning in January 2000, Medicaid will no longer cover Epogen® as a pharmacy service. Pharmacies who provide Epogen® to dialysis patients must seek payment from the dialysis center.

November 3, 1999

“Beginning January 2000, all paper pharmacy claims will be required to be submitted using the new red 061 claim form. Please order a supply of red 061 claim forms now by calling 1-800-289-7799. Discard any old paper claim forms that you may still have on hand. Also note that all fields of the claim form must be filled out completely, including all 11 digits of the NDC code. If an NDC code has leading zeros, even for a compound ingredient, please fill in all 11 digits.”

October 20, 1999

All pharmacy providers are reminded that all quantities are now expressed in metric decimal amounts. Rounding up any quantity to the nearest whole number is no longer necessary, and may result in the submission of a false claim and overpayment. Please review your billing calculations for all inhalation solutions that are frequently packaged in 2.500ml vials, and for injectables such as Neupogen (1.600ml) and Lovenox (0.300ml-0.800ml), and for all eye ointments (3.500gm).

October 15, 1999

All pharmacy providers are reminded that all claims submitted on paper including claims for compound drugs, must include the full 11 digit NDC code for each drug. Do not truncate the NDC code to 9 or 10 digits. Fill in all leading zeros for manufacturers such as Lilly (00002) or Merck (00006). Use the complete 11-digit NDC code even when listing the ingredients of a compound prescription. Paper claims with less than 11 digits in the NDC field will be denied.

October 08, 1999

Effective November 1, 1999, Medicaid prescriptions for Zoloft 50mg must be converted to Zoloft 100mg tablets. A 50mg dose can be achieved by easily breaking the 100mg tablets. A conversion will save nearly $4 million annually. Medicaid patients who are incapable of managing the 100mg one-half tablet dose can still receive the 50mg tablet through prior authorization. The 25mg tablet will also be limited to one per day, but will not require prior authorization.

September 10, 1999

Pharmacy providers are reminded that all quantities are now expressed in metric decimal amounts. Rounding up any quantity to the nearest whole number is no longer necessary, and may result in a false claim and overpayment. Please review your billing calculations for all inhalation solutions that are frequently packaged in 2.500ml vials and for injectables such as Neupogen (1.600ml) and Lovenox (0.300ml – 0.800ml), and for all eye ointments (3.500gm).

August 30, 1999

Effective October 1, 1999, maximum reimbursement for CLOZAPINE 25mg will be $1.01532 per tablet and CLOZAPINE 100mg will be $2.63059 per tablet.

August 20, 1999

All pharmacies providing flu vaccines to nursing home residents are reminded that the metric decimal quantity of a dose of flu vaccine is 0.500 ml, not 1 unit, as has been previously necessary. Any pharmacy claims for flu vaccine that are submitted with a unit of “1” will be denied. In addition, the Medicaid program will not pay for flu or pnuemococcal vaccines if the recipient has Medicare benefits. Medicare is the primary payor for these services.

July 30, 1999

On August 10, 1999, all claims that do not have a valid prescriber’s license number in the prescriber ID field will be denied payment. All Florida licensed prescribers are listed in the Department of Health website, www.doh.state.fl.us, under the menu item “License, Health Professionals, Lookup”. Use the prefix AL or GA followed by the state license number for Alabama and Georgia prescribers who are not licensed in Florida.

April 16, 1999

Effective April 12, 1999, prices for lorazepam are reset to the Federal upper limits for the following manufacturers: Mylan (00378), Rugby (00536), Geneva (00781) and Purepac (00228).

Effective as of April 1, 1999, coverage for Provigil will be approved through prior authorization for use in treating narcolepsy.

March 26, 1999

Effective May 3, 1999, positive prescriber id is required using the practitioner’s Florida license identifying number. ME9999999, MX9999999 or MT9999999 will no longer be accepted as valid values. Resident physicians in training programs have prescriber numbers assigned by their respective boards with the prefixes of ‘UM’ for the allopathic programs and ‘UO’ for the osteopathic programs.

March 15, 1999

Effectively immediately, pricing limits are reinstated for brand name Lasix. Manufacturer’s rebate no longer reduces net Medicaid cost to levels lower than current generic pricing.

Proleukin® is expanded to include renal cell carcinoma, metastic melanoma, non-Hodgkin’s lymphoma, and acute myelogenous leukemia. Prior authorization can be obtained by calling 850-487-4441.

There was an error in the banner message regarding the NDC code for small facemasks for MDI spacers. Effective immediately the correct NDC for the small facemask is 08383-0811-10. Spacers and masks are covered at one per year per recipient. Distributor prices in quantities of 10 for all Medicaid pharmacy providers are available at 1-800-999-8171. The correct NDCs are:

08373-0811-10 Small Face Mask for MDI Spacer (to age 12)

08373-0765-00 Optihaler MDI Spacer

08373-0800-10 Opti-Chamber for MDI Spacer

December 1, 1998

Effective December 1, 1998 reimbursement for Videx Pediatric Powder will be billed according to the total number of mls per bottle. Videx 4 Gm (200ml) bottle will now be billed as total quantity per bottle of 400mls; maximum quantity per prescription will be three (3) bottles or 1200mls with reimbursement of 0.15405 per ml. Videx 2 Gm (100ml) bottle will now be billed as total quantity per bottle of 200mls; maximum quantity per prescription will be three (3) bottles or 600mls with reimbursement of 0.15408 per ml.

Effective December 1, 1998, maximum reimbursement for CLOZAPINE 25mg will be $1.0600 per tablet and CLOZAPINE 100mg will be $2.7200 per tablet.

November 6, 1998

Effective immediately, Medicaid will reimburse for Optichamber and Optihaler spacers for multi dose inhalers used for treatment of respiratory diseases for eligible recipients. Small facemasks for spacers will be covered for pediatric recipients up to age 12. Spacers and masks are covered at one per year per recipient. Distributor prices in quantities of 10 for all Medicaid pharmacy providers are available at 1-800-999-8171. The following NDCs are covered:

08373-0801-10 Small Face Mask for MDI Spacer

08373-0765-00 Optihaler MDI Spacer

08373-0800-10 Opti-Chamber MDI Spacer

August 15, 1998

Effective August 15, 1998, coverage for Proleukin® will be approved through prior authorization for use in renal cell carcinoma and metastatic melanoma. No other indications will be reimbursed.

July 21, 1998

Effective July 31, 1998 coverage for Proleukin® will require prior authorization. The approved indication for Proleukin® is for use in renal cell carcinoma. At this time, this is the only indication that will be reimbursed.

June 30, 1998

Corrections to RV Notice dated June 25, 1998: Effective Date/Reimbursement.

Due to rising costs for food supplements, pricing limits are established for the following enteral products effective July 15, 1998: (Corporate and chain offices, please forward to all pharmacies)

Category 1, 0.5-1.0 cal/ml, natural and semi-synthetic $0.0039 per unit intact protein/isolates (Boost, Complete, Ensure, Ensure,

High Protein, Isocal, NuBasics, Osmolite, Osmolite HN,

Resource, Sustacal)

Category 2, 1.5-2.0 cal/ml, natural and semi-synthetic $0.0044 per unit

intact (Boost Plus, Ensure Plus, Jevity Plus, Nutren 1.5,

Osmolite HN Plus, Resource Plus, Sustacal Plus)

Pseudo NDC numbers for generic and "in-house" brands that do not have a current NDC are:

Category 1 99998-1111-11

Category 2 99998-2222-22

June 25, 1998

Pricing limits are established for the following food supplements effective July 1, 1998:

Category 1, 0.5-1.0 cal/ml, (Low Osmolality) $0.00272 per unit

(Ensure and similar brands)

Category 2, 1.5-2.0 cal/ml, (Moderate to High Osmolality) $0.00325 per unit (Ensure Plus/Sustacal Plus and similar brands)

Pseudo NDC numbers for generic and house brands that do not have a current NDC are:

Category 1 99998-1111-11

Category 2 99998-2222-22

Nutrashake and Nutrashake Lacta Care are exempt from pricing limits due to rebate agreements.

Pricing limits are reinstated for all lorazepam and furosemide tablet dose forms except the brand names Ativan and Lasix respectively, effective May 15, 1998. Manufacturer rebates for Ativan and Lasix brands reduce net Medicaid cost to much lower levels than current generic pricing. No claim certification is required for Ativan or Lasix brand payment to pharmacies.

Viagra is a covered service with the following criteria: Maximum of 4 doses per month, male recipients only, age 19 or older and minimum days supply at 8 per dose.

April 6, 1998

The V-code enabling a dispensing pharmacy to incrementally increase the recipient drug cap has been reinstated, effective April 8, 1998. This code will only be effective for parenterally administered products and will not increase prescription caps beyond 25 total prescriptions. Recipients with requirements exceeding this limit will require a drug exception request approved by the agency. Reinstatement of this coding does not remove the requirement that both the infusion and community pharmacist, if multiple pharmacies provide services, evaluate the patients total drug therapy.