Medicaid engaged Myers and Stauffer, LC, to perform a pharmacy cost of dispensing study. The survey is expected to be mailed on February 17. Please review the Cost of Dispensing Survey Draft. A stakeholder meeting was held on January 27; the presentation materials and recording are available online at
North Dakota Department of Health and Human Services Provider Portal | Myers & Stauffer. Please contact the Myers and Stauffer help desk by email disp_survey@mslc.com or phone 1-800-591-1183. Please note that the help desk phone number has been updated following the January 21 announcement of the stakeholder meeting.
Also in North Dakota, the state's lawmakers approved the Rural Health Transformation Program funding. The state is currently waiting for CMS to approve the grant application. Once approved, the Department of Health and Human Services will post grant opportunities on the Rural Health Transformation Funding Opportunities website. Please sign up for updates on the Rural Health Transformation Program.
Finally in North Dakota, Medicaid provided the following coverage and manufacturer updates.
Coverage Update: Formoterol
Effective January 15: Formoterol was no longer a preferred long-acting beta agonist (LABA) and requires PA [prior authorization].
- Arformoterol and Serevent Diskus remain preferred LABAs and do not require PA.
- Please work with prescribers to transition members to therapeutically appropriate covered alternatives.
Manufacturer Update: Pulmicort Flexhaler
Pulmicort Flexhaler is transitioning NDCs due to a new manufacturer/distributor. New Pulmicort Flexhaler NDCs with labeler code 85612 are not covered by Medicaid.
- The new distributor (labeler code 85612) does not participate in the Medicaid Drug Rebate Program (MDRP).
- Please work with prescribers to transition members to therapeutically appropriate covered alternatives.
- Medicaid preferred inhaled corticosteroids that do not require PA include:
- fluticasone HFA for members 4 years of age and younger.
Medicaid cannot pay for a drug when the manufacturer does not participate in the MDRP due to federal law, Sec.1927. [42. U.S.C. 1396r-8] (a).
- Manufacturers choose whether they will sign up for the MDRP.
- Manufacturer participation is outside of Medicaid's control.
- An alternative, participating manufacturer's product or different drug that is covered, must be used for Medicaid to be able to pay.
Coverage Update: ICS [Inhaled Corticosteroids]/LABA [Long-Acting Beta-Agonist] Inhalers
Effective February 9, Advair HFA and Advair Diskus will be non-preferred status and require PA.
- Dulera will be the only ICS/LABA inhaler that does not require PA.
- All other ICS/LABA inhalers remain non-preferred status and require PA.
- Please work with prescribers to transition members now to avoid treatment disruption.
Dulera contains formoterol and can be used for single-inhaler maintenance-and-reliever therapy (SMART) as recommended in asthma guidelines. Medicaid allows up to two Dulera inhalers per 30-day supply for SMART use.
Effective immediately, claims will reject for strengths that are not indicated for the member's age.
- Electronic age verification occurs during adjudication at the point of sale.
- Please work with the prescriber to use a compendia- and guideline-supported regimen.
Coverage Update: Estrogen Patches
Effective immediately:
- Climara is now preferred (brand is required – bill with DAW 9) and does not require PA.
- Menostar is no longer preferred and requires PA.
- Generic weekly estradiol patch is no longer preferred and requires PA.
- Minivelle is no longer preferred and requires PA.
- Vivelle-Dot remains preferred (brand is required – bill with DAW 9) and does not require PA.
- Generic twice weekly estradiol patch remains non-preferred and requires PA.
- Dotti remains non-preferred and requires PA.
- Lyllana remains non-preferred and requires PA.
Coverage Update: Triptans – Nasal Spray & Injectable
Effective immediately:
- Sumatriptan nasal spray is no longer preferred and requires PA.
- Zolmitriptan nasal spray is now preferred and requires PA.
- Sumatriptan vial now requires PA.
Coverage Update: Interferons
Effective February 1:
- Rebif was no longer preferred and requires PA.
- Betaseron was no longer preferred and requires PA.
- Avonex remains preferred and does not require PA.
Coverage Update: Miscellaneous
Movantik: Effective February 1:
- Movantik was no longer preferred and requires PA.
- Lubiprostone and Symproic remain preferred and do not require PA.
Entresto: Effective immediately:
- Brand Entresto is no longer preferred and requires PA.
- Generic sacubitril/valsartan is preferred and does not require PA.
Topical lidocaine: PA [Prior authorization] is required, but the PA requirement was not being applied to some NDCs during claim adjudication. The system has been updated for those NDCs, so PA is required effective immediately.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
