Prescription services may be provided by and reimbursed to a licensed, enrolled retail pharmacy in accordance with the Wyoming Pharmacy Practice Act, Chapter 8.
Medispan Product Information
- According to the Centers for Medicare and Medicaid Services (CMS), “the Medicaid drug rebate program was created by the Omnibus Budget Reconciliation Act of 1990 (OBRA ’90) and requires a drug manufacturer to enter into and have in effect a national rebate agreement with the Secretary of the Department of Health and Human Services (HHS) for states to receive Federal funding for outpatient drugs dispensed to Medicaid patients”.
Please note that even though a product may be listed as covered by Medicaid (such as diapers or catheters), a particular manufacturer’s product may not be covered if the manufacturer has not submitted all product information to Medi-Span®. It is the manufacturer’s responsibility to submit their product information to Medi-Span®.
Legend Drug Exclusions
For information on legend drugs, product coverage, and over-the-counter products, please refer to our provider manual at http://wymedicaid.org.
Prior Authorization/Preferred Drug List
- For information regarding prior authorization, please visit our prior authorization website at http://wymedicaid.org. Following introduction to the market, new drugs, new formulations of existing drugs, and new indications that are covered through the pharmacy services program will require prior authorization until published literature is available through standard literature review processes. The drug will be considered at the next scheduled P&T Committee meeting, and its coverage status will be reviewed at that time. Exceptions to this rule will be handled on a case by case basis.
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 Pharmacy &Therapeutics (P&T) meetings, please click on the following link to visit our P&T website at http://www.uwyo.edu/DUR/pandtcommittee.
The following reimbursement algorithm applies to all legend drugs, diabetic supplies, medical supplies and OTC medications for all Medicaid Plans:
SMAC is the maximum allowable cost that the State of Wyoming will pay for certain medications. Pharmacy Services has contracted with Change Healthcare (CHC) to manage our SMAC list. Please contact CHC for any questions or dispute issues pertaining to SMAC pricing or reimbursements. All questions should be directed to the CHC POS Help Desk at:
In the event of an emergency, the pharmacy is authorized to dispense up to a seventy-two (72) hour emergency supply. An emergency supply may only be used twice for each drug per month.
For additional information please refer to the Provider Manual.
Mandatory Generic Program
Please refer to the Pharmacy Provider Manual for detailed information regarding the Mandatory Generic Program.
Client Co-payment Fees
The Wyoming Medicaid Pharmacy Program’s co-payment structure is as follows:
- Generics (Multi-source medications) = $0.65
- All Brand-name mediations = $3.65
Wyoming Medicaid clients exempt from the co-payment requirement are:
- Clients under age 21
- Nursing Facility Residents
- Pregnant Women
- American Indians and Alaska Natives
- Family Planning Services
- Emergency Services
- Hospice Services
Pharmacy Services is responsible for detecting fraud and/or abuse within the Medicaid Pharmacy Program. This is accomplished by the review of paid claims history and by conducting field reviews and investigations to determine provider/recipient abuse, deliberate misuse, and suspicion of fraud.
PLEASE REPORT! To report any and all fraudulent activity with Wyoming Medicaid, please call 1-855-846-2563.