Frequently Asked Questions

Q. What medications does Alaska Medicaid cover?

A: Alaska Medicaid pharmacy coverage does not rely on a list of medications, but rather a classification of drugs that are defined in State regulation, 7 AAC 120.110 – 7 AAC 120.112 which is consistent with federal regulation under 42 CFR 447.500.  Those medications that are covered by Alaska Medicaid are ones that are defined by the following criteria:
 
7 AAC 120.110. Covered outpatient drugs and home infusion therapy
     (b)  To be a covered outpatient drug, a drug must be one 
          (1) that may be dispensed only upon a prescription; 
          (2) for which the United States Food and Drug Administration (FDA) requires a national drug code (NDC) number; 
          (3) that is listed electronically with the FDA; 
          (4) for which the manufacturer has obtained a new drug application or an abbreviated new drug application from the FDA; and 
          (5) for which federal Medicaid matching funds are available.
 
In order for federal Medicaid matching funds to be available, among other things such as medically necessary, the  manufacturer has to have signed a national Medicaid Drug Rebate Agreement.

• Prescription Drugs
• Medicaid Drug Rebate Program

These drugs are called "Covered Outpatient Drugs".

Q: How do I determine if a drug has any special requirements such as quantity limits or prior authorization?

A: To determine if a prior authorization is required for a particular drug (regardless of status on the PDL) or it there are quantity limits, the Department maintains a resource page at:

• Medication Prior Authorization Page

Q: What happens if my patient need to exceed quantity limits for a particular drug due to their specific medical needs?

A: Prescribers may submit a prior authorization for the Stat to review medical necessity.

Q: I am a Pharmacist.  Where do I find information on how to bill Alaska Medicaid Pharmacy Claims?

Billing information may be found in the Pharmacy Provider Billing Manual.
 
Q: I am a Physician, Nurse Practitioner, or Physician Assistant.  Where do I find information on how to bill Alaska Medicaid for medications I administer in my clinic?

A: Billing information may be found in the Physician, Advanced Nurse Practitioner, Physician Assistant Provider Billing Manual.

Q: I can't find the drug I'm looking for on the Preferred Drug List.

A: The Preferred Drug List (PDL) is not all-encompassing as it only represents a sub-set of drug classes.  A subsection of the PDL is updated after each Pharmacy and Therapeutics Committee meeting. Categories A, B, C, and D coincide with the four public meetings held each year. The PDL is posted to the Alaska Medicaid pharmacy website approximately 30 days prior to becoming effective.

Q: Who will decide what drugs will be listed on the PDL?

A:  “The Preferred Drug List (PDL) development process includes input from a number of entities – the Pharmacy and Therapeutics (P&T) Committee, local Alaskan health care professionals, and the Drug Utilization Review contractor – Prime Therapeutics Medicaid Administration.  Local Alaskan health care professionals may submit written comments or may appear in person at the P&T Committee meetings and provide oral testimony.  Industry representatives are allowed an opportunity to provide clinical information about their respective medications through written dossier submittals and 3-minutes of public testimony at the meeting.  All industry materials and testimony must comply with FDA law and regulations on drug labeling and promotion.  Industry testimony, including health care professionals speaking on behalf of industry, that does not comply with FDA rules will be reported to the FDA’s Office of Prescription Drug Promotion (OPDP).

The recommendations from the P&T Committee and supplemental rebate bids received through Alaska Medicaid’s participation in the National Medicaid Pooling Initiative (NMPI) are considered by DOH-HCS Pharmacy professionals when developing the final Preferred Drug List (PDL).  DOH-HCS Pharmacy professionals take into consideration the clinical evidence available within the class, clinical benefits and risks of the drugs within the class, as well as the overall impacts to the Alaska Medicaid program with regards to both pharmacy and medical services utilization.  DOH-HCS clinical staff make the final determination of PDL status after considering the available clinical information and committee recommendations.”

Q: How will a PDL help cut prescription drug costs?

A: Pharmacy costs will be reduced by a partnership with drug manufacturers, who will give supplemental rebates to reduce the cost of the drugs.

Q: What drugs will be on the PDL?

A: Drugs in specified drug classes will be approved for the PDL based on clinical efficacy, safety and cost. Drug Lookup Tool

Q: What about drugs not on the PDL?

A: Non-preferred drugs will require the prescriber to document the medical necessity of using the drug. Certain groups of recipients may be exempt from the PDL requirements – for example, certain age groups. Drugs in classes that are not included on the PDL are not subject to the non-preferred drug documentation requirements.

Q: When are the P&T meetings and when are drug classes reviewed?

A: The P&T Committee meets four (4) times a year on the third Friday of September, November, January and April. Meeting dates and a schedule for the year are usually posted during the summer. A detailed agenda for each meeting is posted noticed and posted online 30 days prior to the meeting.

Q: What do the different class colors mean?

A: The class colors represent the changes to the drug class since the last review and whether drug manufacturers can provide verbal testimony at the P&T meeting. “Red classes” have new medications added since the last review. Drug manufacturers may provide verbal testimony for products in a red class. “Blue classes” have no new medications, but one or more medication within the class has a new indication or warning. Manufacturers may provide verbal testimony for products in a blue class, but the information should be limited to the new information available. “Green classes” have no new medications or indications. Manufacturers cannot provide verbal testimony at the P&T meeting for products in a green class.

Q: How can manufacturers provide input on a reviewed product?

A: Manufacturers can provide information in a number of ways. Clinical information can be submitted for a reviewed product in writing using the Clinical Submission Form (available online). The clinical submission form must be submitted on or before the PhRMA submission date posted online. Information submitted in writing will be distributed with the materials to the P&T Committee members with their materials. Manufacturers may also provide verbal testimony at the P&T Committee meetings either in person or by phone. Verbal testimony is limited to 3 minutes per manufacturer per drug class and is only allowed for red or blue classes. The State will not solicit industry comment beyond the Clinical Submission Form posted online; the decision to provide written information or verbal testimony is up to each manufacturer. Public comment submitted by providers that have been compensated by a manufacturer must have the relationship with the manufacturer clearly stated and will be treated as manufacturer submitted written information. Any written information submitted by a manufacturer after the PhRMA submission date will not be distributed to the P&T Committee members.

Q: How can the public and uncompensated practitioners provide comments on a reviewed medication or drug class?

A: Public comment may be submitted prior to the committee meeting in writing prior to the HCS Pharmacy Services Team at 4601 Business Park BLVD, Building K, Anchorage, AK 99503, via email at hcs_pharmacy@alaska.gov, or via fax at 907-561-1684. Public comment from recipients and practitioners will also be taken at the beginning of the P&T Committee meetings either in person or via phone. If a provider is compensated to submit comment or testimony the relationship between the provider and manufacturer must be clearly stated and the comments will be treated as verbal testimony or written information submitted by a manufacturer and not as public comment.

Q: Where can I find out more about the PDL?

A: Providers or recipients may contact the HCS Pharmacy Services Team at 907-334-2425 or email to hcs_pharmacy@alaska.gov or Charles Semling at charles.semling@alaska.gov with questions. Manufacturers or industry representatives must contact the Prime Therapeutics Medicaid Administration Technical Call Center or Rebate Unit with all questions regarding coverage or claims processing questions.

Q: Can a manufacturer request a meeting with a representative of Health Care Services to share new clinical or financial information?

A: Yes; Pharmaceutical Manufacturers may request a meeting with the Pharmacy Program Manager to share new clinical, outcomes, or financial data for their product(s). All meetings must be requested in advance by sending an email to hcs_pharmacy@alaska.gov. All meetings will occur on the last Tuesday of the month (August through May) between 1:00pm and 4:00pm and will last for no more than 30 minutes in length. Meetings will be scheduled on a “first come, first served” basis. Meeting will be scheduled no more often than once every six (6) months per manufacturer. This policy applies to in-person meetings, conference calls and webinar presentations. This policy does not apply to the submission of clinical information to the Pharmacy and Therapeutics Committee by manufacturers using the Submission Request Form for Pharmaceutical Manufacturers form. 

Q: How does the program ensure that the information considered by the Committee is fair and balanced?

A: The program requires Committee members to complete a form annually to disclose any possible conflict of interest situations. Members of the public, including health care professionals, are provided a Conflict of Interest Disclosure Form to complete.  The Committee is provided with this information; if no form is received, the Committee is advised that no disclosure has been received.  The program also uses the CMS Open Payments database to identify any potential financial conflicts of interest.