P&T Committee Meetings in 2012
April 20, 2012
May 11, 2012
October 19, 2012
November 16, 2012
Unless otherwise posted in the agenda, meetings start at 9am with public testimony received from 9:30am to 10:30am. All meetings are held at Idaho Medicaid at 3232 Elder Street in Boise.
DUR Board Meetings in 2012
January 19, 2012
April 19, 2012
July 19, 2012
October 18, 2012
State Holidays for 2012
New Years Day - January 2
Martin Luther King Jr Day - January 16
President’s Day – February 20
Memorial Day – May 28
Independence Day – July 4
Labor Day – September 3
Columbus Day – October 8
Veteran’s Day – November 12
Thanksgiving – November 22
Christmas Holiday – December 25
Contact Info
Prior Authorization Requests (Monday through Friday 8am to 5pm)
(208) 364-1829 or toll free 1(866) 827-9967
Prior Authorization Status Inquiry (24/7, 365 days/years)
1(800) 922-3987
P&T Committee
Tami Eide, PharmD
(208) 364-1829
J-Code Questions
Jeanne Siroky
(208) 364-1897
Eligibility Questions
(800) 922-3987
DME (Durable Medical Equipment)
Includes diabetic supplies (e.g. test strips), nutritional supplies, incontinence supplies.
1(866) 686-4272
Magellan Medicaid Administration – Provider Line
1(800) 922-3987
Magellan Medicaid Administration – Participant Line
1(888) 773-9466
72 Hour Emergency Supply
Idaho Medicaid will pay for point-of-sale (POS) pharmacy claims for a 72 hour emergency supply of medications requiring prior authorization if the pharmacist in his/her professional judgment believes a participant has an immediate need. The appropriate prior authorization process must be used during regular business hours. All of the following conditions must be met for an emergency supply:
- The participant is Medicaid eligible on the date of service
- The prescription is new to the pharmacy
- The medication requires prior authorization
- The supply for the emergency period does not exceed three days
The override codes for billing for a 72 hour emergency supply are:
- Reason for Service Code: TP (Payer/Processor Question)
- Professional Service Code: MR (Medication Review)
- Result of Services Code: 1F (filled, with different quantity)
A completed prior authorization request must be faxed to 800-327-5541.
Medicare Part D Participants
The only drug classes covered by Idaho Medicaid for dual eligible participants (i.e. participants who are also on Medicare) are: barbiturates, benzodiazepines, cough/cold medications, folic acid, injectable vitamin B12, iron, legend Vitamin D, and Vitamin K.
Spacers for Inhalers
Spacers are reimbursable by Idaho Medicaid through the DME (durable medical equipment) program and do not require prior authorization. One spacer is authorized per six months.
All spacers should be billed using the CMS 1500 with the following HCPC procedure codes:
- S8100 – holding chamber or spacer used with an inhaler or nebulizer, without mask
- S8101 – holding chamber or spacer for use with an inhaler or nebulizer, with mask