Effective April 1, the Medicaid Agency will:

1. Continue to monitor the stimulant shortage affecting ADHD (attention-deficit/hyperactivity disorder) medications. Should you need assistance, please contact Acentra Health at the number below for alternative prescribing and dispensing options.
2. Require PA (prior authorization) for generic liraglutide. Brand Victoza will remain preferred and will be billed with a Dispense as Written (DAW) Code of 9.

Acentra Health

Medicaid Pharmacy Administrative Services

P.O. Box 3570, Auburn, AL 36831

Fax: 1-800-748-0116

Phone: 1-800-748-0130

View the alert for additional details.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Alabama Medicaid Agency (Medicaid) provides full Medicaid benefits for eligible pregnant individuals during pregnancy and 12 months postpartum. Medicaid does not require positive confirmatory pregnancy testing for maternity Medicaid coverage.

Pregnant individuals may apply for Medicaid programs using the single streamlined Medicaid application.

• Online application (fast service),
• Paper application (mailed to Medicaid),
• Phone application by calling the Recipient Call Center at 1-800-362-1504 (toll-free), Monday through Friday, 8:00 am until 4:30 pm or
• In-person application at a local county health department, a federally qualified health care center (FQHC), the regional Alabama Coordinated Health Network (ACHN) or some local hospitals.

For questions related to maternity Medicaid eligibility, providers may contact Gainwell Technologies at 1-800-688-7989.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Pharmacist registrations with Board of Pharmacy expire December 31, 2024. The Board of Pharmacy is accepting pharmacist license renewals online only. As a reminder, the Board transitioned to a new database last month. The new system and renewal process look different, and the changes will require individuals to create a new account to renew licenses. Pharmacies and facilities will not need to create a new account. Instead, each pharmacy will be linked to the supervising pharmacist, and each facility will be linked to the designated representative. For information, watch the tutorial videos on the ALBOP YouTube channel.

Also in Alabama, effective January 1, 2025, the Alabama Medicaid Agency’s Durable Medical Equipment (DME) Program will cover E2298, PWR SEAT ELEVATION SYS (Power Seat Elevation System), for adults 21 years of age and older. Prior authorization (PA) will be required. E2298 will continue to be covered for children under 21 years of age with a PA. The limit will be one (1) per two (2) calendar years for both adults and children. Policy questions concerning this provider notice should be directed to the DME Program at (334) 242-5050.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

During the Board of Pharmacy’s September monthly meeting, the Board discussed the strategic plan to address the findings of the Department of Examiners of Public Accounts (Public Examiners). The plan will be available on the Board’s website.

Also in Alabama, Medicaid issued an ALERT regarding RSV Prevention Criteria for the 2024-2025 season, including the following information.

• Beyfortus® (nirsevimab), a long-acting monoclonal antibody product, was approved by the US Food and Drug Administration (FDA) on July 17, 2023, for use in newborns and infants to protect against (medically attended) respiratory syncytial virus (RSV).
• On August 3, 2023, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) voted unanimously in favor of recommending use of Beyfortus® as indicated in its FDA package insert.
• Beyfortus® will be administered and dispensed through the Vaccines for children Program (VFC) administered through Department of Public Health. Therefore, Beyfortus® will not be eligible for billing through the Medicaid pharmacy program.

Finally in Alabama, Medicaid issued an ALERT on October 1 as a follow-up to the ALERT dated August 1, regarding the new Disclosure Form that is posted on the Alabama Medicaid Agency (Medicaid) website. Effective October 1 and after Medicaid will enforce the new Disclosure Form.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Effective October 1, 2024, Medicaid will:

1. Continue to monitor the stimulant shortage affecting ADHD medications.
2. Add the Asthma and Allergy Monoclonal Antibodies class to the PDL.
3. Require PA for generic bepotastine besilate ophthalmic solution, and generic budesonide/formoterol fumarate inhalation, including Breyna. Brand Bepreve and brand Symbicort will remain preferred and will be billed with a Dispense as Written (DAW) Code of 9.
4. Update the PDL to reflect the quarterly updates listed at the link.

Also in Alabama, this ALERT was published on July 2, 2024; however, Medicaid sent the information to providers again as a reminder of upcoming changes starting on October 1, 2024, related to COVID-19 unwinding.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Mandatory provisions of the Affordable Care Act require the Medicaid Agency (Medicaid) to select and provide oversight for a Medicaid Recovery Audit Contractor (RAC) to perform provider audits. Alivia Analytics, LLC (Alivia) was selected to be Medicaid’s RAC effective October 1, 2024. The RAC program is designed to improve payment accuracy by identifying under and overpayments in Medicaid. The Medicaid RAC program is separate from the Medicare RAC overseen by the Centers for Medicare and Medicaid Services.

Reviews will be conducted by Alivia staff to include a medical director, certified professional coders and experienced clinicians. Audits will be conducted by Alivia using a “top down” approach where data analysis, through data mining, is applied against the universe of paid claims to identify patterns of utilization or billing which look atypical based on Medicaid and/or national standards. Following the high-level claims analysis, Alivia may expand its review by requesting clinical records and/or other documents in accordance with state and federal regulations.

Alivia has been informed of the critical role that all providers play in a successful Medicaid program and requires that auditors be professional, objective and consistent in performing all required audits/reviews.

Providers are reminded that the Alabama Administrative Code, the Provider Manual and their Provider Agreements require compliance with requests for medical records for Medicaid program audits.

Questions regarding the audits should be directed to Jamie Cousins, RAC Program Manager, at (334) 353-8025 or Yulonda Carter, Recipient Review Associate Director, at (334) 242-5161.

Also in Alabama, the State Board of Pharmacy will transition to a new database in October of this year. The new system and the renewal process will look different. The changes will ultimately be positive but require you to create a new account to renew licenses, permits and registrations.

Finally in Alabama, as a reminder, 2024 is a year for pharmacist license renewals and pharmacy permit renewals.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Medicaid will begin to migrate the remaining recipients from the Alabama Medicaid Agency Eligibility System (AMAES) to the newer Centralized Alabama Recipient Eligibility System (CARES) in June 2024. Medicaid anticipates the process will be completed by July 1, 2024.  

Medicaid recipients with a Medicaid ID number starting with 500 will get a new Medicaid ID number that starts with 530 (unless they already have a 530 Medicaid number). New Medicaid cards will be sent to recipients who do not already have a Medicaid card with the new 530 number.  

Recipients in nursing facilities may receive a new Medicaid number but not a card. Medicaid is “linking” the old Medicaid ID number to the new Medicaid ID number. Recipients may continue to use the old Medicaid ID number during June 2024. Once numbers are linked, either number will work. Providers who need assistance may call the Medicaid Provider Assistance Center at 1-800-688-7989. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The 2024 Legislative Session has adjourned. A Legislative Study Group is being developed over the summer to address the PBM issues in Alabama. 

Also in Alabama, as a reminder, federal regulations require states to conduct a fingerprint-based criminal background check on providers or any person with five percent or more direct or indirect ownership interest in the provider who meets any of the criteria listed in the ALERT pursuant to 42 C.F.R. § 455.450. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.