Downloads

This page includes links to manuals, documents, forms, and delimited data files.

Manuals

• Pharmacy Provider Procedure Manual
• Pharmacy Provider Payer Sheets
• Drug Manufacturer Manual

Documents

• Enrollment documents
  • Pharmacy Delivery Signage
• Education documents
  • Dispensing 72-hour Emergency Prescriptions Instructions
  • Mosquito Repellent Benefit Information
  • Pharmacy Resources for Managed Care Information
  • Real-time Eligibility Verification Information
• Managed care documents
  • Pharmacy Enrollment Chart
  • Pharmacy Assistance Chart
  • Prescriber Assistance Chart
  • Service Area Information
• Formulary Management documents
  • Electronic Certificate of Information User Guide
  • Drug Addition Process
  • Preferred Drug List
  • Preferred Drug List Criteria Guide (PDF)
  • Specialty drug process (PDF)
  • Specialty drug submission spreadsheet (XLS)
• 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
  • Retrospective Drug Use Criteria

Forms

• For pharmacies
  • Refer to the list of enrollment forms
  • Refer to the list of claim processing forms
  • Refer to the list of formulary management forms
    • Long-acting reversible contraception product forms
  • Refer to the list of prior authorization requests for Medicaid FFS
  • Refer to the list of prior authorization requests for CSHCN
• For manufacturers
  • Refer to the list of formulary management forms
  • Refer to the list of drug rebate agreements
  • Refer to the list of value-based agreements
  • Refer to the list of rebate administration forms

Data Files

• † Weekly file last updated Jan. 17.
• ‡ Quarterly file last updated Jan. 12.
• * File last updated Nov. 2021