Information for Providers
Revision of approval criterion for certain brand medically necessary drugs
November 1, 2004
Effective immediately, the Department of Health and Family Services is
revising one approval criterion for certain brand medically necessary (BMN)
narrow therapeutic index (NTI) drugs.
100 Day Supply for Prescription Drugs Letters
Prescribing Provider Letter
Pharmacy Provider Letter
Wisconsin Medicaid, BadgerCare, and SeniorCare allow a limited number of
maintenance drugs to be dispensed in a 100-day supply to assure continuity of
use for certain necessary medications.
Wisconsin Administrative Code (HFS 109)
The SeniorCare chapter of the Wisconsin Administrative Code (HFS 109) is now
available to providers from Wisconsin Medicaid. Regulations associated with the
Wisconsin Medicaid SeniorCare program are covered in HFS 109, Wis. Admin. Code.
Wisconsin SeniorCare Covered Drug Search Tool
The Wisconsin SeniorCare covered drug search tool is designed for Wisconsin
Medicaid certified pharmacies and other health care providers to help identify
and calculate ingredient rates of drugs covered by SeniorCare.
Publications about SeniorCare for Wisconsin Medicaid providers
Reimbursement Changes for Pharmacy Claims
BadgerCare Plus Update, September 2008 (2008-181)
Summary:
This BadgerCare Plus Update provides
information about changes included in the 2007-09 biennial budget, Wisconsin Act
20, for retail pharmacies dispensingdrug services. |
More
Brand Medically Necessary Prior Authorization Requirements
BadgerCare Plus Update, June 2008 (2008-40)
Summary:
BadgerCare Plus is revising its brand medically necessary drug prior
authorization (PA) policy. The intent of the
brand medically necessary drug PA is to ensure that brand name drugs are being
prescribed appropriately when generic equivalent drugs are available.
A revised Prior Authorization/Brand Medically Necessary Attachment (PA/BMNA),
HCF 11083 (07/08), and completion instructions are attached to this
BadgerCare Plus Update. The revised PA/BMNA is effective for PA requests
received on and after July 1, 2008. Documentation guidelines for PA requests for
brand name drugs are also included.
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More
Spring 2008 Preferred Drug List Review
BadgerCare Plus Update, March 2008 (2008-25)
Summary:
This BadgerCare Plus Update provides
information for prescribers and pharmacy providers about changes to
the Preferred Drug List. Changes are effective for dates of service on
and after April 2, 2008. |
More
Introducing ForwardHealth interChange, a New Web-Based Information System
for State Health Care Programs
BadgerCare Plus Update, March 2008 (2008-24)
Summary:
In October 2008, the Department of Health and Family
Services (DHFS) will implement ForwardHealth interChange, which
replaces Wisconsin’s existing Medicaid Management Information System.
With ForwardHealth interChange, providers and trading partners will
have more ways to verify member enrollment; submit electronic claims,
adjustments, and prior authorization requests through the secure
ForwardHealth Portal.
The Portal supplements and compliments existing ways for providers
to do business with DHFS health care programs.
More information on ForwardHealth interChange will be issued in
future publications. |
More
Reminder: Tamper-Resistant Prescription Pad Requirement Effective April 1,
2008
BadgerCare Plus Update, March 2008 (2008-22)
Summary:
Providers are reminded that, effective April 1, 2008,
federal legislation requires that prescriptions for Medicaid and
BadgerCare Plus members that are not telephoned, faxed, or
electronically transferred to a pharmacy be written or printed on
tamper-resistant prescription pads or computer paper. To assist with
facilitation of this new requirement, the Wisconsin Department of
Health and Family Services is currently offering a limited supply of
free tamper-resistant prescription pads and computer paper to
Medicaid-certified prescribers. |
More
Health Care Providers Are Required to Report Their National Provider
Identifier to Wisconsin Medicaid Immediately
BadgerCare Plus Update, March 2008 (2008-19)
Summary:
In preparation for federal implementation of National Provider Identifiers (NPIs) on May 23, 2008, all certified health care
providers, who have not already done so, are required to report their
NPI to Wisconsin Medicaid immediately. Reporting NPI information now
is essential to conducting future business when Wisconsin Medicaid
implements NPI, replacing current eight-digit provider numbers.
Health care providers are reminded that Wisconsin Medicaid is only
collecting NPI information at this time. Therefore, as previously
published, providers are required to continue indicating their
eight-digit provider number, even after reporting their NPI, until
further notice.
Information on NPI and how to report NPI is detailed in this
BadgerCare Plus Update. |
More
Limited Supply of Free Tamper-Resistant Prescription Pads Now Available,
BadgerCare Plus Update, February 2008 (2008-18)
Summary:
Effective April 1, 2008, federal legislation requires
that prescriptions for Medicaid and BadgerCare Plus members that are
not telephoned, faxed, or electronically transferred to a pharmacy be
written or printed on tamper-resistant prescription pads or computer
paper. In order to facilitate implementation of this new requirement,
the Wisconsin Department of Health and Family Services will provide a
limited supply of free tamper-resistant prescription pads to
Medicaid-certified prescribers. This BadgerCare Plus Update
provides information regarding how to request these free prescription
pads. |
More
Tamper-Resistant Prescription Pad Requirement Delayed
Wisconsin Medicaid and BadgerCare Update, October 2007 (2007-67)
Summary:
Recent federal legislation delayed implementation of a new law requiring
prescriptions for Medicaid recipients that are not phoned, faxed, or
electronically transferred to a pharmacy to be written or printed on
tamper-resistant prescription pads or computer paper.
| More
Fall
2007 Preferred Drug List Review
Wisconsin Medicaid and BadgerCare Update, September 2007 (2007-66)
Summary:
This Wisconsin Medicaid and BadgerCare Update provides information for
prescribers and pharmacy providers about changes to the Preferred Drug List.
Changes are effective for dates of service on and after October 1, 2007. |
More
Tamper-Resistant Prescription Pad Requirement
Wisconsin Medicaid and BadgerCare Update, September 2007 (2007-65)
Summary:
Effective October 1, 2007, federal law imposes a new requirement on
prescriptions paid for by Medicaid, SeniorCare, or BadgerCare fee-for-service.
The law requires that all written or computer-generated prescriptions that are
given to a patient to take to a pharmacy must be written or printed on
tamper-resistant prescription pads or tamper-resistant computer paper. This
requirement applies to prescriptions for both controlled and noncontrolled
substances. This Wisconsin Medicaid and BadgerCare Update provides
information regarding implementation of this new federal requirement for
prescribers and dispensing providers. |
More
Diagnosis Code Restrictions and Quantity Limits for Altabax™,
Bactroban®, and Mupirocin
Wisconsin Medicaid and BadgerCare Update, September 2007 (2007-64)
Summary:
This Wisconsin Medicaid and BadgerCare Update revises the diagnosis code
restrictions and establishes quantity limits for Altabax™, Bactroban®, and
mupirocin. Information about claim submission and prior authorization are also
included. Information in this Update applies to Wisconsin Medicaid and
BadgerCare recipients and Wisconsin SeniorCare participants. |
More
SeniorCare Extended to December 31, 2009
Wisconsin Medicaid and BadgerCare Update, June 2007 (2007-47)
Summary:
SeniorCare is a prescription drug assistance program for Wisconsin residents 65
years of age or older who meet the eligibility requirements. The program is
designed to help seniors with their prescription drug costs. SeniorCare began on
September 1, 2002, and was due to expire on June 30, 2007. However, an amendment
to a supplemental appropriation bill signed by the President has extended
SeniorCare to December 31, 2009. |
More
Reminder: Wisconsin Medicaid Will Not Implement the National Provider
Identifier on May 23, 2007 — Medicaid Provider Numbers Will Continue to Be
Required
Wisconsin Medicaid and BadgerCare Update, May 2007 (2007-39)
Summary:
This article is a reprint of Wisconsin Medicaid and
BadgerCare Update 2007-12, published in February 2007. |
More.
Medicare Part D Payment Recoupment
Wisconsin Medicaid and BadgerCare Update, March 2007 (2007-26)
Summary:
This Wisconsin Medicaid and BadgerCare Update provides
information about recoupment of payments by Wisconsin Medicaid and
Wisconsin SeniorCare that are the responsibility of a Medicare Part D
Prescription Drug Plan (PDP). Information included in this Update
applies to providers who serve individuals enrolled in a Medicare Part
D PDP, including Wisconsin Medicaid dual eligibles and SeniorCare
participants. |
More.
Wisconsin Medicaid Will Not Implement the National Provider Identifier on May
23, 2007 - Medicaid Provider Numbers Will Continue to Be Required
Wisconsin Medicaid and BadgerCare Update, February 2007 (2007-12)
Summary:
Wisconsin Medicaid will not implement the National Provider Identifier (NPI)
on May 23, 2007. Providers are required to continue to indicate their
eight-digit Medicaid provider number on all electronic and paper claims and
other transactions (e.g., prior authorization) submitted to Wisconsin Medicaid
on and after May 23, 2007. Claims submitted without an eight-digit Medicaid
provider number will be denied. This requirement will continue until
providers are notified otherwise in a future Wisconsin Medicaid and
BadgerCare Update. |
More
Medicare Part D True Out-of-Pocket Information for Wisconsin SeniorCare
Wisconsin Medicaid and BadgerCare Update, December 2006 (2006-97)
Summary:
This Wisconsin Medicaid and BadgerCare Update describes the
true out-of-pocket claim submission process for SeniorCare participants
with incomes over 200 percent of the Federal Poverty Level who are
enrolled in a Medicare Part D Prescription Drug Plan. |
More
Fall 2006 Preferred Drug List Revision
Wisconsin Medicaid and BadgerCare Update, October 2006 (2006-86)
Summary:
This Wisconsin Medicaid and BadgerCare Update includes a revision to
a Preferred Drug List (PDL) class published in the September 2006 Update
(2006-76), titled “Fall
2006 Preferred Drug List Review.” Actonel will be retained as a preferred
drug in the bone resorption suppression and related agent class. A revised
Preferred Drug list to reflect this change will be posted to the Medicaid Web
site. |
More
100-Day Supply Drug Policy and Drug Utilization Review Alert
Wisconsin Medicaid and BadgerCare Update, October 2006 (2006-85)
Summary:
Effective for dates of service on and after October
23, 2006, Wisconsin Medicaid and SeniorCare will alert providers of
opportunities to dispense drugs in quantities up to a 100-day supply.
Providers will receive a Drug Utilization Review alert with this
information. |
More
Fall 2006 Preferred Drug List Review
Wisconsin Medicaid and BadgerCare Update, September 2006 (2006-76)
Summary:
This Wisconsin Medicaid and BadgerCare Update provides
information for prescribers and pharmacy providers about changes to
the Preferred Drug List. Effective dates for these changes are
outlined in this Update. |
More
Wisconsin Medicaid Allows Dose Consolidation and Tablet Splitting
Wisconsin Medicaid and BadgerCare Update, August 2006 (2006-72)
Summary:
This Wisconsin Medicaid and BadgerCare Update provides information
about the following:
- Dose consolidation.
- Tablet splitting.
More
SeniorCare
Coordination of Benefits with Medicare Part D
Wisconsin Medicaid and BadgerCare Update, July 2006 (2006-65)
Summary:
Effective for dates of process on and after September
1, 2006, Wisconsin Medicaid will enforce the previously published
coordination of benefits policy for SeniorCare participants who are
also enrolled in Medicare Part D. This policy was introduced in the
January 2006 Wisconsin Medicaid and BadgerCare Update
(2006-05), titled “Coordination
of Benefits for SeniorCare Participants Enrolled in Medicare Part D.”
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More
Atypical Antipsychotic Drug Class Added to Preferred Drug List and Prior
Authorization/Preferred Drug List Forms Revised
Wisconsin Medicaid and BadgerCare Update, June 2006 (2006-50)
Summary:
This
Wisconsin Medicaid and BadgerCare Update provides information for
prescribers and pharmacy providers about the atypical antipsychotic
drug class that will be added to the
Preferred Drug List
beginning July 5, 2006. The revised
Prior Authorization/Preferred Drug List (PA/PDL) Exemption Request,
HCF 11075 (fillable PDF, 29 KB) (Rev. 06/06), and the
Prior Authorization/Preferred Drug List (PA/PDL) for Stimulants and
Related Agents, HCF 11097 (fillable PDF, 37 KB) (Rev. 06/06), are also included in this
Update. |
More
Revised Preferred Drug List Information
Wisconsin Medicaid and BadgerCare Update, February 2006 (2006-33)
Summary:
This Wisconsin Medicaid and BadgerCare Update contains information about the following revisions to the Wisconsin Medicaid Preferred Drug List (PDL):
- Effective for dates of service on and after March 1, 2006, Tamiflu® (oseltamivir) and Relenza® (zanamivir) will be added to the PDL as preferred drugs during influenza season.
- Effective immediately, prior authorization criteria for Byetta® (exenatide) has been revised. |
More
Coordination of
Benefits for SeniorCare Participants Enrolled in Medicare Part D
Wisconsin Medicaid and BadgerCare Update, January 2006 (2006-05)
Summary:
This Wisconsin Medicaid and BadgerCare Update provides information
about the coordination of benefits and claims submission processes for Wisconsin
SeniorCare participants who are enrolled in a Medicare Part D Prescription Drug
Plan. | More
New Dispense as Written Code in Point-of-Sale Claims Processing System
Wisconsin Medicaid and BadgerCare Update, December 2005 (2005-73)
Summary:
This Wisconsin Medicaid and BadgerCare Update provides information
about Dispense as Written code “5,” which will be implemented in the pharmacy
Point-of-Sale claims processing system on and after January 1, 2006. |
More
Wisconsin Medicaid Enters Multi-State Preferred Drug List and Supplemental
Rebate Program
Wisconsin Medicaid and BadgerCare Update, September 2005 (2005-60)
Summary:
This Wisconsin Medicaid and BadgerCare Update provides information
for prescribers and pharmacy providers about changes to the Preferred Drug List
(PDL) and information about the multi-state PDL. I
More
Information About A New Class Added to the Preferred Drug List
Wisconsin Medicaid and BadgerCare Update, August 2005 (2005-44)
Summary:
This Wisconsin Medicaid and BadgerCare Update provides information about the
cytokine and cell adhesion molecule antagonist drug class that will be added to
the Wisconsin Medicaid Preferred Drug List. |
More
Expanded Preferred Drug List Information for Pharmacy Providers
Wisconsin Medicaid and BadgerCare Update, June 2005 (2005-31)
Summary:
The Preferred Drug List will be expanded for Wisconsin Medicaid and
BadgerCare fee-for-service and Wisconsin SeniorCare on July 1, 2005. |
More
Point-of-Sale Enhancement and Claims Submission Requirement for Recipients with
Commercial Health Insurance
Wisconsin Medicaid and BadgerCare Update, May 2005 (2005-28)
Summary:
This Update announces that:
- Effective for claims received on and after June 9, 2005, providers are
required to bill all commercial health insurance carriers prior to Wisconsin
Medicaid when a recipient has verified drug coverage through commercial health
insurance. As a result, Appendix 9 of the Claims Submission section of the
Pharmacy Handbook is no longer valid.
- The new implementation date when a Drug Utilization Review alert and a
Pharmaceutical Care service may be submitted in the same transaction is June
9, 2005. The enhancement was originally announced in the September 2004
Update (2004-78), titled "Drug
Utilization Review and Pharmaceutical Care Services May Be Submitted in the
Same Transaction."
More
New Preferred Drug List Information for Dispensing Providers
Wisconsin Medicaid and BadgerCare Update, March 2005 (2005-17)
Summary:
The Preferred Drug List will be expanded for Wisconsin
Medicaid and BadgerCare fee-for-service and Wisconsin SeniorCare on
April 1, 2005. |
More
Preferred Drug List Information for Dispensing Providers
Wisconsin Medicaid and BadgerCare Update, December 2004 (2004-93)
Summary:
The Preferred Drug List will be expanded for Wisconsin Medicaid and BadgerCare
fee-for service and Wisconsin SeniorCare on January 1, 2005. |
More
Drug Utilization Review and Pharmaceutical Care Services May Be Submitted in
the Same Transaction
Wisconsin Medicaid and BadgerCare Update, September 2004 (2004-78)
Summary:
Effective for claims processed on and after December 14,
2004, Wisconsin Medicaid is enhancing the pharmacy real-time claims
submission process in the Point-of-Sale system to allow a response to a
Drug Utilization Review alert and Pharmaceutical Care service claim to
be submitted in the same transaction. |
More
Prescriber
Information on the Wisconsin Medicaid Preferred Drug List
Wisconsin Medicaid and BadgerCare Update, September 2004 (2004-77)
Summary:
Effective for dates of service on and after October 1, 2004, the Division of Health
Care Financing is implementing a Preferred Drug List (PDL) and Supplemental Rebate
Program for Wisconsin Medicaid and BadgerCare fee-for-service and SeniorCare. Drug
classes will be added to the PDL in 2004 and 2005.
This Wisconsin Medicaid and BadgerCare Update outlines prescribers’
responsibilities for drugs on the PDL. Dispensing providers are receiving a separate
Update regarding their responsibilities for drugs on the PDL. This Update
also includes information on how to access PDL information. | More.
Dispensing
Provider Information on the Wisconsin Medicaid Preferred Drug List
Wisconsin Medicaid and BadgerCare Update, September 2004 (2004-76)
Summary:
Effective for dates of service on and after October 1, 2004, the Division of Health
Care Financing is implementing a Preferred Drug List (PDL) and Supplemental Rebate
Program for Wisconsin Medicaid and BadgerCare fee-for-service and SeniorCare. Drug
classes will be added to the PDL in 2004 and 2005.
This Wisconsin Medicaid and BadgerCare Update is for dispensing providers.
Prescribers are receiving a separate Update that includes information about
their responsibilities for drugs on the PDL. |
More.
Pharmacy Information
on Prior Authorization Requirements for Brand Medically Necessary Drugs
Wisconsin Medicaid and BadgerCare Update, August 2004 (2004-62).
Summary:
Effective for dates of service (DOS) on and after September 1, 2004, Wisconsin Medicaid,
BadgerCare, and SeniorCare require prior authorization (PA) for brand medically necessary
drugs. Prior authorization policies for brand medically necessary drugs are discussed in
this Wisconsin Medicaid and BadgerCare Update.
Effective for DOS from September 1, 2004, to September 30, 2004, brand name
Clozaril® will have a different PA submission process. Providers may find
information on the PA submission process for brand name Clozaril® in this
Update.
In addition to describing new PA requirements for brand medically necessary drugs,
this Update provides an overview of Wisconsin Medicaid, BadgerCare, and SeniorCare
drug coverage, PA requirements, and other restrictions. |
More.
Archived Information for Providers
Date Last Revised:
September 24, 2008
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