Documents

• Manuals
• Pharmacy Payer Sheets
• Enrollment documents
  • Pharmacy Delivery Signage
• Education documents
• Managed care documents
  • MCO Contact and Pharmacy Claims Billing Information
  • MCO Service Area Information
• Formulary Management documents
  • Electronic Certificate of Information (eCOI) User Guide
  • Medicaid Formulary Addition Process
  • Preferred Drug List
  • Preferred Drug List Criteria Guide (PDF)
  • Specialty drug submission spreadsheet
• Prior Authorization call center documents
  • Registration (PDF)
  • Provider Quick Reference (PDF)
• Clinical Prior Authorization documents
  • Clinical Prior Authorization criteria guides
  • Clinical Prior Authorization assistance chart
• Drug Utilization Review Board documents
  • Agendas
  • Meeting summaries
  • Meeting minutes
  • Preferred Drug List recommendations
  • Preferred Drug List decisions

Forms

• For pharmacies
  • Enrollment forms
  • Claim processing forms
  • Formulary management forms
    • Long-acting reversible contraception product forms
  • Prior authorization requests for Medicaid FFS
  • Prior authorization requests for CSHCN
• For manufacturers
  • Formulary management forms
  • Drug rebate agreements
  • Value-based agreements
  • Rebate administration forms

Data Files

• † Weekly file last updated June 05.
• ‡ Quarterly file last updated April 19.
• * File last updated Feb. 2022