Vermont

Medicaid has updated its contact information due to the transition of Change Healthcare (CHC) to Optum.

Also in Vermont, the Department of Vermont Health Access (DVHA) continues a phased recovery following the outage that occurred in February 2024, due to the national cyber security issue affecting Optum/Change Healthcare. Beginning August 7, 2024, edits for Reject-75, Prior Authorization Required, will return to normal functioning in the pharmacy claims system.

• Claims for non-preferred items on the Preferred Drug List (PDL), including medications obtained during the outage, that do not have an active Prior Authorization on file, will now begin to reject. This also includes preferred medications subject to clinical review and medications requiring step therapy. Please refer to the PDL for medication specific coverage criteria.
• An emergency fill can be dispensed when a required prior authorization has not been secured, and the need to fill the prescription is determined to be an emergency. If the prescriber cannot be reached to obtain the required prior authorization, the pharmacist may dispense an emergency supply to last up to 72 hours.

Please continue to refer to the Preferred Drug List to review preferred and non-preferred medications. Providers requiring assistance with submitting a prior authorization may contact the Optum Pharmacy Helpdesk at VermontHD@Optum.com, the Prescriber Helpdesk at (1-844-679-5363) or the Pharmacy Helpdesk at (1-844-679-5362).

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.