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The purpose of this memo is to notify providers of the retirement of Chapter 8 “Appendix D: Preferred Drug List / Common Core Formulary Changes, and Drug Utilization Review Board Service Authorization Changes” and Chapter 9 “Appendix E: DMAS 90 Day Supply List” from the Pharmacy manual. This update is to remove redundancies and ensure the most up-to-date Pharmacy resource information is readily available. 

All available information from Appendix D: Preferred Drug List / Common Core Formulary Changes, and Drug Utilization Review Board Service Authorization Changes can be found in the posted Pharmacy Manual Chapter 4: Covered Services and Limitations within the Preferred Drug List Program section or the Service Authorization (SA) Process section respectively.  The Preferred Drug List / Common Core Formulary information can be accessed at: https://www.virginiamedicaidpharmacyservices.com/provider/preferred-drug-list/ and is updated quarterly upon conclusion of the Pharmacy and Therapeutics Committee meeting. The Drug Utilization Review Board Service Authorization information can be accessed at: https://www.virginiamedicaidpharmacyservices.com/provider/authorizations/ and is updated quarterly upon conclusion of the Drug Utilization Board meeting. Finally, the summary of the Formulary and Service Authorizations changes is disseminated quarterly through a Medicaid Bulletin.

Information previously from Appendix E: DMAS 90 Day Supply List can be found in the posted Pharmacy Manual Chapter 4: Covered Services and Limitations within the Days’ Supply Limitations section. This includes a website link to the list accessed at: https://www.virginiamedicaidpharmacyservices.com/provider/documents/. 

To avoid disruption to claims payment through FFS and the MCOs providers must periodically check the DMAS provider portal, also known as the Provider Services Solution (PRSS), to ensure that the provider's enrollment, contact information, and license information is up to date, for all of the provider's respective service locations. Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS. Additional information is provided on the MCO Provider Network Resources webpage and includes links to resources, tutorials and contact information to reach Gainwell with any provider enrollment or revalidation related questions.  Dental providers should continue to enroll directly through the DMAS Dental Benefits Administrator, DentaQuest.