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Outpatient Pharmacy Services

DMA Clinical Policy and Programs, Outpatient Pharmacy
Phone: 919-855-4300
Fax: 919-715-1255

What’s New

• October 2009 Pharmacy Newsletter
• All Pharmacy Newletters
• New Enhanced Specialty Discount on Single-Source Specialty Drugs (9/15/08)
• 2009/2010 Synagis Season (10/1/09)
• Tamper Resistant Prescription Pads
• Information on changes to the Outpatient Pharmacy Program to reduce costs, including changes to reimbursement methodology, is available on DMA's Budget Initiatives web page.

Prior Authorization (PA)

Prior authorization is required for certain drugs prescribed to North Carolina Medicaid recipients. Each drug that is on the prior authorization list is monitored to determine the effect of the prior authorization process on utilization and appropriate use. More Prior Authorization Information

Outpatient Pharmacy Policies

• Outpatient Pharmacy Program, 9
• Over the Counter Medications, A2
• Mental Health Drug Management Program Administrative Procedures, A5
• Prior Authorization for Outpatient Pharmacy Point of Sale Medications, A3

Drug Utilization Review (DUR)

• DUR Board Meeting Dates, Minutes, and Agenda

Controlled Substances Task Force

• Meeting Minutes, May 11, 2009
• Meeting Minutes, August 10, 2009

Reimbursement

• Enhanced Specialty Drugs List
• Federal Upper Limit (Federal MAC)
• State Maximum Allowable Cost (SMAC) List - Last Updated November 15, 2009
  • Microsoft Excel Format (328 KB)
  • Adobe Acrobat Format (109 KB)
• State Maximum Allowable Cost (SMAC) and Specialty Drug Pricing Inquiry Worksheet

Prescription Advantage List (PAL)

• PAL Pocket Card (PDF)
• For more information about PAL (including an interactive tool), visit the NC Physicians Advisory Group website.

Outpatient Pharmacy Forms

• Focused Risk Management FORM) Medication Review Documents
• Focused Risk Management Program (FORM) Instructions
• Pharmacy Adjustment Request (372-200)
• Pharmacy Claim Form
• Pharmacy Online Request Form
• Pharmacy Provider Enrollment
• Prior Authorization Forms
• State Maximum Allowable Cost (SMAC) Pricing Inquiry Worksheet
• Synagis Policy and Forms 2009-2010
  • Policy and Procedures
  • Synagis For RSV Prophylaxis Form
  • PA Synagis Request Form

Pharmacy Links

• Active Drug Rebate Labeler Codes (24 KB) (revised 8/15/09)
• Getting Ready for Medicare D 2009, Reminders to NC Pharmacists (12/11/08)
• More Medicare Part D Info

Outpatient Pharmacy (DMA Clinical Policy and Programs) Contacts

• Phone: 919-855-4300
• Lisa Weeks, PharmD, RPh (Acting Chief, Pharmacy and Ancillary Services)
• Glenda Adams, PharmD, RPh (Coordinator, Drug Utilization Review)
• Charlene Sampson, RPh (Lead Pharmacist, Behavioral Pharmacy Management, Synagis Program)
• Amy Williams, PharmD, RPh (Lead Pharmacist, Pharmacy Prior Authorization Program)
• Deidre Alford, CPT Candidate (Administrative Assistant, Outpatient Pharmacy Program)