Now Brand Preferred: Please bill with DAW9 to receive brand rates
Ventolin HFA
Diastat
No longer Brand Preferred: You can bill with DAW9 until April 30th to use up your supply
Cellcept oral suspension
Nuvigil
Revatio
Silenor
Faslodex
Epclusa
DME for Nursing Homes: effective April 5th
Pharmacies will receive a denial for DME that should be supplied by the nursing home. The most common examples are needles and lancets. The NCPDP rejection will be 70-Product/Service Not Covered with the message “DME items not covered for patients in long term care – Facility must provide DME for patients”. We have mistakenly been paying for these since late 2018, but can’t continue to cover them going forward.
Please bill venlafaxine 225mg IR or ER dose as (75mg x 3) tablets or capsules rather than (150mg + 75mg) tablets or capsules
WSI/Worker’s Comp: effective immediately
There will no longer be denials because of WSI coverage. Any money paid by ND Medicaid that is the responsibility of WSI will be identified retrospectively and recouped from WSI as necessary, not the pharmacy; however, please continue to bill WSI in cases where they are known to be responsible.
We have seen an increase in call volume for 19-Inv Days Supply which means that pharmacies are billing a correct day supply and calling with denials. We appreciate the extra time that is being taken to bill day supply accurately.
