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 First Data Bank

 

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.acs-inc.com/manuals/pharm/limits.pdf.

 

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.asp. 

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 Preferred Drug List Advisory Committee (PDLAC).  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 PDLAC meetings, visit our PDL website at http://uwacadweb.uwyo.edu/PDL/.
 

Reimbursement:

Drugs billed through the pharmacy claims system are reimbursed at the lower of AWP - 11% + $5, usual and customary, Federal Upper Limit (FUL) or State Maximum Allowable Cost (SMAC). 

SMAC is the  maximum allowable cost that the State of Wyoming will pay for generic multi-source medications. The Office of Pharmacy Services has contracted with Myers and Stauffer to manage our SMAC list. Please contact Myers and Stauffer for any dispute issues pertaining to SMAC pricing, and to review our SMAC list please click on:

  Myers and Stauffer 

 

J-codes are generally reimbursed at 95% of AWP.