Brand Required
These medications will be brand required starting 11/1/2020:
- Invega ER
- Tegretol Oral Solution
Strattera: For pharmacies unable to see Strattera brand available for purchase from their wholesalers, please let them know we are requiring brand and request them to order some in for you to purchase. We have talked with wholesalers and the manufacturer, and the issue seems to be from a lack of demand, not a lack of supply.
PA is not needed for brand name use: As a reminder, the generics for brand-required medications will deny with a message to use brand name as well as the NCPDP rejection of 75-Prior Authorization Required. A prior authorization is not needed from the prescriber, except to maintain the generic when brand is preferred. The pharmacy can bill the brand name with a DAW9 without prior authorization from the prescriber. An exception to the brand requirement is available if the recipient has other primary insurance.
Billing Vaccines
After referring to the Professional Claim Web Portal Submission Instructions, if you need help navigating the portal or billing vaccines, please contact the medical call center rather than the pharmacy call center.
- The medical call center’s number is 701-328-7098 or you can email at mmisinfo@nd.gov.
Reminder that vaccines must be billed to Sanford Health Plan if the recipient is enrolled with Medicaid Expansion. Eligibility can be determined by using the following:
- The Automated Voice Response System can be used as outlined on pages 7 and 8 of the General Information of the Providers Manual or within the web portal under the members tab.
- These will not return eligibility for Medicaid Expansion recipients.
- Call ND DHS Eligibility at 1-844-854-4825 or Sanford Health Plan at 1-855-305-5060.
NDC Drug Lookup
We are in the process of converting to a new NDC Drug Lookup. The current NDC Drug Look-up site will be soon retired. A website redesign will occur in coming months when the new lookup tool is fully updated.
Medicare Part D
Prescription Medications: ND Medicaid does not provide prescription drug benefits for recipients eligible for Medicare Part A or B
- If a recipient is eligible for Medicare Part A or B and Medicaid, the recipient must enroll with Part D to receive prescription drug benefits. ND Medicaid does not provide drug benefits for these recipients even if they choose to not enroll into a Part D plan.
- For temporary drug coverage after a recipient qualifies for Medicare, please utilize the Humana LI NET program. This program provides immediate and retroactive drug coverage for individuals who qualify for both Medicare and Medicaid, but do not yet have prescription drug coverage through Part D. Many helpful links are found on Medicare’s Limited Income NET Program webpage including links to:
- This program is not administered by ND Medicaid. Please contact the Humana help desk at 1-800-783-1307 or Humana.com/LINET for assistance.
Non-prescription Medications: ND Medicaid covers a select number of non-prescription medications that are not covered by Part D when all prescription alternatives are exhausted first
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