Pharmacy related information is presented in the following panels. Clicking on any links presented on the panels will cause a new window to appear from which information can be reviewed or downloaded.
Pharmacy Program Publications: Provides links to pharmacy related documents, including:
- Pharmacy Prior Authorization Form
- Proton Pump Inhibitor PA Form
- MedWatch Form FDA 3500
- NCPDP 5.1 Pharmacy Reject Codes
- Federal Upper Limit on Drugs (used to insure that the Federal Government acts a prudent buyer of drugs)
- Drug Manufacturer Rebate Lists (to include the CADAP and Medicaid programs)
- CADAP Formulary Update
- CT Tuberculosis (TB) Medication Formulary
- CT Family Planning (FAMPL) Medication Formulary
- State of Connecticut MAC List
- MAC Pricing Inquiry Worksheet
- Monthly MAC Updates
- Nursing Home Drug Return List
- 14-day Supply Flier
Preferred Drug List Information: Contains an overview of the PDL. The PDL is a list of Medicaid drugs recommended by Pharmaceutical and Therapeutics Committee. A link for downloading the latest version of the PDL is provided along with links for Prior Authorization forms, Methodologies, and PDL Legislation. Clicking the link opens a new window. A toll-free number is provided to address any questions, comments, or concerns.
Pharmaceutical and Therapeutics Committee: General information about the committee members and meetings. Links for committee law and ethic documents are provided. When these links are clicked, a new window opens, and the files can be downloaded. Also, any parties that would like to interact with Committee members can download the submission guidelines by using the link provided.
Pharmacy Prior Authorization Program: Information about the Pharmacy Prior Authorization Program, including links to State Law Requirements, Prior Authorization criteria, instructions for claims processing, Prior Authorization request forms, and Frequently Asked Questions.
Retrospective Drug Utilization Review Program: Information about the RetroDUR program and lock-in, with links to DUR board information, agendas and meeting minutes.
Drug Rebate: Contains links to the application for ConnPACE Drug Rebate participation and information on J-Codes for Professional claims.