East Providence, RI 02915. When generic drugs are available, we will not cover the brand-name drug without giving prior approval. We’re open Monday through Friday, from 8 a.m. to 6 p.m. Division of Medicaid Services F-11075 (09/2013) FORWARDHEALTH . Which formulary should I use? Medicaid programs and Medicaid MCOs may manage the list of covered drugs through a Preferred Drug List (PDL) and/or prior authorization. Most large-chain and independent pharmacies can fill them. Attention: North Dakota Medicaid no longer uses EAC to determine payment, however, you will continue to see this information while using NDC Drug Lookup. Not eligible for Medicaid or HealthSource RI? If you qualify, you can enroll in Medicaid at any time. The Ohio Department of Medicaid (ODM) administers the program which encompasses over 30,000 line items of drugs from nearly 300 different therapeutic categories. The PDP promotes the use of less expensive, equally effective drugs when medically appropriate through a Preferred Drug List (PDL). ); Compare 2021 Rhode Island plan details with the 2020 plans; Show 2021 Medicare Part D plans for a different state PRIOR AUTHORIZATION / PREFERRED DRUG LIST (PA/PDL) EXEMPTION REQUEST . You can also call us at 866.738.4116 (TTY: 711). 2020 Low-Cost Generic Drug List. ._o�P�Pײ�B��� � �65�~�6Pf�1��RK�[��m��D�zj������Ϣ���E�������ݺ���Z bH$[Wa�a�Ki���.�RG`��07DN�� �`�%;N{q��� ���{�#H��a���n�^�� ��3��3pGߓ����P$�ҏ���y��e���$��_�{?�#��)M@�c����b��b����r,F�P�[T3+�$U���a��PI�>(�$�� �PT�X���_�[email protected]>@`���Q�?z�.�r_�O�6��/��w�mRC .��n�D&�QH�6X�H��D�]S��ӿ*��z ��=�s>ʊr�~. Rhode Island Medicaid covers methadone under Fee-For-Service (FFS) plans. All PDL products are on HCA’s Apple Health Preferred Drug List that is used by managed care plans and the fee-for-service program. Rhode Island has expanded coverage to low-income adults. Preferred Drug List – Acceptable drugs by the State. FQHs should immediately begin billing for the wrap-around payment and should no longer bill for the copay, coinsurance and deductible. Drugs generally excluded from payment in the Rhode Island Medicaid Program, such as: Drugs used in the treatment of hair growth, e.g., Minoxidil Solution; Drugs used in the treatment of infertility, e.g., Clomiphene Citrate. Fax – 1 (401) 784-3889. If you are uninsured and are not eligible for Medicaid or coverage through HealthSource RI, you may qualify for health services through The Rhode Island Free Clinic or Clínica Esperanza. Instructions: Type or print clearly. %PDF-1.7 %���� Who is eligible for Medicaid? Effective January 1, 2020. State Benefits at a Glance. 1332 Waiver - June 2020 Public Meeting Notice. This site is run by a trusted partner of HealthSource RI, but we are not responsible for its content. 2021 Low-Cost Generic Drug List. This Drug Formulary does not guarantee coverage and is subject to change without notice. Show your Tufts Health Plan and Rhode Island Medicaid ID cards to the pharmacy staff. The PDL applies only to drugs you get at retail and specialty pharmacies. AL: Age Limit Restrictions . Effective January 1, 2021. Quick links to Rhode Island plan tools: See all Rhode Island national and regional Medicare Part D (PDP) plan details (copays/coinsurance, plan ratings, formulary, enrollment figures, etc. 2020 MEDICAID DRUG FORMULARY Effective October 1st, 2020 PLEASE READ: THIS DOCUMENT HAS INFORMATION ABOUT THE PRESCRIPTION DRUGS WE COVER. All other trademarks or service marks appearing in this site are property of their respective owners. Privacy Policy & Conditions of Use. What’s a cost sharing reduction and do I qualify? Generic drug: Lowercase in plain type . Health plans available through Medicaid and HealthSource RI both offer a similar set of important benefits, called essential health benefits. Individuals apply for health coverage through HSRI and depending upon their income, they may be eligible for Medicaid or eligible to purchase an insurance plan (possibly with financial assistance). The PDL is a medication list recommended to DOM by the P&T Committee and approved by the executive director of DOM. Medicaid Coverage of Medications for the Treatment of Opioid Use Disorder. How are drugs placed on … Before completing this form, read the Prior Authorization/Preferred Drug List (PA/PDL) Exemption Request Completion Instructions, F-11075A. Call 1-855-840-4774 to speak to an enrollment specialist or find a certified enroller in your area. Medicaid covers low-income adults, children, seniors, persons with disabilities, pregnant women, children in foster care and former foster youth up to age 26. Drugs designated as preferred have been selected for their … Individuals & Families: 1-855-840-4774Employers & Employees: 1-855-683-6757, 1-855-840-4774 Fee-for-service plan only Preferred drug lists (PDL) The Apple Health (Medicaid) Fee-For-Service Preferred Drug List no longer applies. H���[O�@��-�?�vU6{�H *Q(MՇ�Lb�4�T�����8�8 TTY: 1-888‐657-3173 What is the difference between Medicaid and HealthSource RI? These individuals do not have to send in any paperwork to keep their coverage, and we will take steps to ensure their coverage does not terminate. Find a certified enroller in your area. 0 All drugs currently covered by Fee-For-Service (FFS) Medicaid remain available under the PDP and the determination of preferred and non … Effective immediately, coverage will be protected for all individuals who have Medicaid as of March 18, 2020 and for all individuals approved for Medicaid coverage during the COVID-19 national emergency through the end of the month in which the emergency period ends. If you are not sure what type of coverage you have, remember that Medicaid members do not pay for monthly coverage and also have an anchor card. Medicaid coverage will only end if an individual requests termination of eligibility or if they are no longer resident of the state or have changes in citizenship or immigration status. Members will not lose coverage or have a decrease in benefits for any other reason. endstream endobj 10930 0 obj <>stream Please refer to your “Member Handbook or other plan materials” to determine if your drug is covered. h�bbd``b`���v�%��, It is not an exclusive list of drugs covered by Medicaid and includes approximately 35% of all Medicaid covered drugs. In 2012 in Rhode Island, 20.2% of persons aged 12 and older who met criteria for having a drug use disorder received treatment. In Rhode Island, we offer plans from Neighborhood Health Plan of Rhode Island, Tufts Health Plan, UnitedHealthcare and RIte Smiles. The PDL is not an all-inclusive list of covered medications or medications that require prior authorization. How to Write You may need to check with your employer to know which formulary you should use. We can also tell you if you qualify for financial help to lower your costs. h�b```� ,@ (������D�&�F 6�v+�\Ƨ�:,��.�Y,X�1�`9�4�-��;��>�����Blgy� Hours: hޜ�Yk�0���ޗ�Ö(���M��Y(}P�;����Ռ����]�Dc͡�̧p���0��!Q �LQ�$ P��H�b gLH���� j�& �%'1Z Legend . £(D5 5%wwt��S����v�M�S�e�5LW����*���SFg���(�ѭ"��1��sC�I�� You can apply online on HealthSourceRI.com. What is Medicaid?Medicaid is a program that offers free or low-cost health coverage for people with limited income and resources. You are leaving the informational HealthSource RI page and entering our secure website for comparing and purchasing health insurance coverage. If you are no longer eligible for Medicaid, contact HealthSource RI. Adding a New Provider to an Existing Group; RIte Share Providers; Local Education Agency (LEA) Providers; National Provider Identifier Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. The PDL does ... Rhode Island has a Generic First Program and requires that all members use generic drugs first. DHS, EOHHS, and HealthSource RI worked together to design Rhode Island’s new, state-of-the-art eligibility system. New York Medicaid Medicaid-Approved Preferred Drug List. Effective with date of service January 1, 2013, RI Medicaid will pay the difference between the total primary payment and the FQH encounter rate for recipients enrolled in RIte Share. As of August 2020, Rhode Island has enrolled 312,213 individuals in Medicaid and CHIP — a net increase of 63.61% since the first Marketplace Open Enrollment Period and related Medicaid program changes in October 2013. β … Methadone. PDL_January_1_2020.pdf. The state of Rhode Island has designated the Executive Office of Health and Human Services (EOHHS) as the single state agency to administer the Medicaid State Plan. ".AZJ��p�*�睿�Q�u�����f蒢���++�¹���*p �Z�n*�^�a+ This web-based system determines eligibility for Medicaid, Human Services Programs, and other forms of affordable healthcare coverage using a single, streamlined application. You can also apply in person at your local Department of Human Services (DHS) office or by phone by calling HealthSource RI at 1-855-840-4774. Name Description Date ; MaineCare Preferred Diabetic Supply List- Effective July 1, 2020 171.08 KB: 2020/07/30: Search Tool for Excel Documents 15.5 KB: 2005/02/24: Search Tools for PDF Documents 166 KB: 2005/02/24: For … To avoid a gap in your health coverage, let us help you pick a new plan before your Medicaid coverage ends. If you get a Medicaid notice telling you that you or a member of your household no longer qualify for Medicaid due to changes in income or your household, you may be eligible to enroll in a health plan through HealthSource RI, but you must act fast. �1�3�2ڰ�c\ø�1���5�Ig��� �����o��.�E���_��C��O}/�d`���y��p���XN� �M0fr���Ĝ��)��Q�����t��a`Rn�a`�� ˷0���[email protected]� T�q RHODE ISLAND. Effective December 1, 2020. Pharmacy Preferred Drug List (PDL) Effective September 21st, 2020 Non-preferred medications require prior authorization Page 1 of 21 ANALGESICS Drug Class Preferred Requires Prior Authorization Long-Acting Narcotics* * Clinical criteria apply to this entire therapeutic class Embeda® fentanyl 12, 25, 50, 75, 100 mcg/hr (transdermal) Brand name drug: Uppercase in bold type . Your application through HSRI will determine your options. Jointly funded by the state and federal government, health coverage is provided for varying groups of Rhode Island residents, including pregnant women, families with children, adults without dependent children, disabled individuals, and seniors. Rhode Island 4-tier Formulary; Low-Cost Generic Drug Program. You will receive a notice from the Department of Human Services letting you know if you were approved, denied or if they require more information in order to make a determination.  It is very important for you to respond if information is requested. ��V,>�~s��,й����u����1��u�s�Eà�#J,Pb���*�A ��s� #��8F �iGO�ʈ�3��Dʹ�I����P 8Ѻ��OKQk8N�_qd 1��Ds�B%A��շw0 The Rhode Island Department of Human Services (DHS) is announcing new Call Center hours Monday through Friday. Executive Office of Health and Human Services Rhode Island Medicaid Fee for Service Preferred Drug List (PDL) Fax: 1-401-223-6317, 401 Wampanoag Trail What can you do in the RI Medicaid Health Care Portal. Through this secure and easy to use internet portal: Healthcare providers and Billing Agents can enroll as a Trading Partner with RI Medicaid. During Open Enrollment: Additional PDL News & Info. The PDL provides continued access to prescription medications while ensuring that Medicaid pays the lowest cost for medications. In Rhode Island, we offer plans from Neighborhood Health Plan of Rhode Island, Tufts Health Plan, UnitedHealthcare and RIte Smiles. Mon-Fri 8:00 a.m. – 6:00 p.m. Rumford, RI 02916, HealthSource RI is the official healthcare portal for the state of Rhode Island. If you need help applying or have questions, you can Find Help for free. %%EOF For list of participating pharmacies near you, use our Find a Doctor, Hospital or Pharmacy tool. You only have 60 days from the date listed in the Medicaid notice to enroll in HealthSource RI during your Special Enrollment Period. For more information, call the Rhode Island Department of Human Services’ Medicaid department at the phone number provided below. 10941 0 obj <>/Filter/FlateDecode/ID[<6EA84CAE2F71594BB18352FE486D4B5A><7917EBE51CAAA84FB6E36917517C5593>]/Index[10926 29]/Info 10925 0 R/Length 79/Prev 325471/Root 10927 0 R/Size 10955/Type/XRef/W[1 2 1]>>stream this Preferred Drug List (PDL) to be used when prescribing for patients covered by the pharmacy benefit plan offered by UnitedHealthcare Community Plan. What’s a cost-sharing reduction and do I qualify? For individuals who see messaging in their account and/or have received paper notices that their coverage is ending after March 18, 2020, no change in coverage will occur at this time. In each class, drugs are listed alphabetically by either brand name or generic name. - 10/8/2020 ; View all Apple Health Preferred Drug List that is used managed. 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