Information for Pharmaceutical Companies

 

PRODUCT COVERAGE:

 

The Wyoming Medicaid Pharmacy Program covers all legend drugs that:

• Have a signed rebate agreement in place
• Are registered with Medispan

 

The Wyoming Medicaid Pharmacy Program will not cover:

• Agents used for weight loss, hair loss or fertility
• Cosmetic agents, including Retin-A and Differin products for clients over the age of 21
• Agents used for weight gain, including anabolic and androgenic steroids.
• Some medications require prior authorization. Additional information may be found by clicking on the Preferred Drug List/Prior Authorization (PDL/PA) menu tab on the Office of Pharmacy Services home page.

 

For additional information on product coverage, including over-the-counter products, please refer to our provider manual at:

 

 http://wyequalitycare.org 

 

 

Prior Authorization/Preferred Drug List:

To review information for medications which are subject to prior authorization please visit our prior authorization website at:

 

http://uwacadweb.uwyo.edu/DUR/priorauthorization 

If your product is a drug which falls in a therapeutic class currently listed on the Preferred Drug List, it may require prior authorization.  Specifically, if your product is a new formulation of an existing chemical entity (longer acting, sustained release, etc) it will likely automatically require prior authorization. 

 

If your product is a combination of two or more drugs, one of which falls into a therapeutic class currently listed on the Preferred Drug List, it will likely not automatically require prior authorization. 

 

The status of your product will be revisited following additional review of the therapeutic class by the Pharmacy & Therapeutics (P&T) Committee. For information regarding therapeutic classes currently listed on our Preferred Drug List (PDL), a timeline for future review of therapeutic classes, and agendas for upcoming P&T  meetings, please click on the following link to visit our P&T website:

 

 http://www.uwyo.edu/DUR/pandtcommittee 

 

Reimbursement:

All legend drugs, diabetic supplies, medical supplies and OTC medications for all Wyoming EqualityCare plans will be reimbursed at the following:

 

The lesser of SMAC, FUL, AWP – 11% or Submitted Ingredient Cost + $5.00 dispensing fee, Usual and Customary, or Gross Amount Due, whichever is less.

 

Questions regarding reimbursements should be directed to the GHS POS Help Desk at:

 

Goold Health Systems

Provider Relations Unit

P.O. Box 21719

Cheyenne, WY  82003-7032

1-877-209-1264