S3�KvS�ο�5]��7��,@�-%d��\�p`�*n`�������b�Z���`Fy�Q)0*y��}���O�ݗ��}��k��� ��� East Providence, RI 02915. FQHs should immediately begin billing for the wrap-around payment and should no longer bill for the copay, coinsurance and deductible. If you are no longer eligible for Medicaid, contact HealthSource RI. Medicaid programs and Medicaid MCOs may manage the list of covered drugs through a Preferred Drug List (PDL) and/or prior authorization. ._o�P�Pײ�B��� � �65�~�6Pf�1��RK�[��m��D�zj������Ϣ���E�������ݺ���Z bH$[Wa�a�Ki���.�RG`��07DN�� �`�%;N{q��� ���{�#H��a���n�^�� ��3��3pGߓ����P$�ҏ���y��e���$��_�{?�#��)M@�c����b��b����r,F�P�[T3+�$U���a��PI�>(�$�� �PT�X���_�W@o>@`���Q�?z�.�r_�O�6��/��w�mRC .��n�D&�QH�6X�H��D�]S��ӿ*��z ��=�s>ʊr�~. Which formulary should I use? The PDL is a medication list recommended to DOM by the P&T Committee and approved by the executive director of DOM. endstream endobj 10930 0 obj <>stream This Drug Formulary does not guarantee coverage and is subject to change without notice. It is not an exclusive list of drugs covered by Medicaid and includes approximately 35% of all Medicaid covered drugs. Executive Office of Health and Human Services Rhode Island Medicaid Fee for Service Preferred Drug List (PDL) TTY: 1-888‐657-3173 2020 Low-Cost Generic Drug List. The Statewide PDL includes only a subset of all Medicaid covered drugs. Medicaid Coverage of Medications for the Treatment of Opioid Use Disorder. These individuals do not have to send in any paperwork to keep their coverage, and we will take steps to ensure their coverage does not terminate. 10926 0 obj <> endobj Jointly funded by the state and federal government, health coverage is provided for varying groups of Rhode Island residents, including pregnant women, families with children, adults without dependent children, disabled individuals, and seniors. Would you like to continue? You will receive a notice from the Department of Human Services letting you know if you were approved, denied or if they require more information in order to make a determination.  It is very important for you to respond if information is requested. This web-based system determines eligibility for Medicaid, Human Services Programs, and other forms of affordable healthcare coverage using a single, streamlined application. Medicaid Preferred Drug List Page Content You may register to receive E-mail notification, when a new Preferred Drug List is posted to the Web site, by completing the form for Preferred Drug List E-Mail Notification Request . endstream endobj startxref The PDL does ... Rhode Island has a Generic First Program and requires that all members use generic drugs first. Generic drug: Lowercase in plain type . ); Compare 2021 Rhode Island plan details with the 2020 plans; Show 2021 Medicare Part D plans for a different state If you and your provider feel a generic drug is not EOHHS currently administers the Medicaid program through five internal offices: Program Integrity, Legal, Budget and Finance, Policy and Innovation, and Healthcare Administration. Rumford, RI 02916, HealthSource RI is the official healthcare portal for the state of Rhode Island. In 2012 in Rhode Island, 20.2% of persons aged 12 and older who met criteria for having a drug use disorder received treatment. PRIOR AUTHORIZATION / PREFERRED DRUG LIST (PA/PDL) EXEMPTION REQUEST . Preferred Drug List – Acceptable drugs by the State. hޜ�Yk�0���ޗ�Ö(���M��Y(}P�;����Ռ����]�Dc͡�̧p���0��!Q �LQ�$ P��H�b gLH���� j�& �%'1Z Mon-Fri 8:00 a.m. – 6:00 p.m. What can you do in the RI Medicaid Health Care Portal. HealthSource RI is the state’s marketplace for buying and comparing health insurance plans. 10941 0 obj <>/Filter/FlateDecode/ID[<6EA84CAE2F71594BB18352FE486D4B5A><7917EBE51CAAA84FB6E36917517C5593>]/Index[10926 29]/Info 10925 0 R/Length 79/Prev 325471/Root 10927 0 R/Size 10955/Type/XRef/W[1 2 1]>>stream What is Medicaid?Medicaid is a program that offers free or low-cost health coverage for people with limited income and resources. How to Write Through this secure and easy to use internet portal: Healthcare providers and Billing Agents can enroll as a Trading Partner with RI Medicaid. The Rhode Island Department of Human Services (DHS) is announcing new Call Center hours Monday through Friday. 0 Drugs generally excluded from payment in the Rhode Island Medicaid Program, such as: Drugs used in the treatment of hair growth, e.g., Minoxidil Solution; Drugs used in the treatment of infertility, e.g., Clomiphene Citrate. What’s a cost-sharing reduction and do I qualify? Call 1-855-840-4774 to speak to an enrollment specialist or find a certified enroller in your area. Copyright 2013-2020 ® HealthSource RI logo is the trademark and service mark of the HealthSource RI. All other trademarks or service marks appearing in this site are property of their respective owners. Privacy Policy & Conditions of Use. Attention: North Dakota Medicaid no longer uses EAC to determine payment, however, you will continue to see this information while using NDC Drug Lookup. When generic drugs are available, we will not cover the brand-name drug without giving prior approval. β … Methadone. Adding a New Provider to an Existing Group; RIte Share Providers; Local Education Agency (LEA) Providers; National Provider Identifier What is the difference between Medicaid and HealthSource RI? Drugs designated as preferred have been selected for their … Medicaid & CHIP This category provides information about Medicaid and the Children's Health Insurance Program (CHIP), states’ health coverage programs for low-income children and adults. State Benefits at a Glance. You can apply online on HealthSourceRI.com. ".AZJ��p�*�睿�Q�u�����f蒢���++�¹���*p �Z�n*�^�a+ As of August 2020, Rhode Island has enrolled 312,213 individuals in Medicaid and CHIP — a net increase of 63.61% since the first Marketplace Open Enrollment Period and related Medicaid program changes in October 2013. Official website for the Neighborhood Health Plan of Rhode Island. The PDP promotes the use of less expensive, equally effective drugs when medically appropriate through a Preferred Drug List (PDL). Effective January 1, 2020. You might also qualify for free or “charity care” from one of our local hospitals. If you are uninsured and are not eligible for Medicaid or coverage through HealthSource RI, you may qualify for health services through The Rhode Island Free Clinic or Clínica Esperanza. Effective with date of service January 1, 2013, RI Medicaid will pay the difference between the total primary payment and the FQH encounter rate for recipients enrolled in RIte Share. We can also tell you if you qualify for financial help to lower your costs. If you need help applying or have questions, you can Find Help for free. Name Description Date ; MaineCare Preferred Diabetic Supply List- Effective July 1, 2020 171.08 KB: 2020/07/30: Search Tool for Excel Documents 15.5 KB: 2005/02/24: Search Tools for PDF Documents 166 KB: 2005/02/24: For … Please refer to your “Member Handbook or other plan materials” to determine if your drug is covered. Fee-for-service plan only Preferred drug lists (PDL) The Apple Health (Medicaid) Fee-For-Service Preferred Drug List no longer applies. Quick links to Rhode Island plan tools: See all Rhode Island national and regional Medicare Part D (PDP) plan details (copays/coinsurance, plan ratings, formulary, enrollment figures, etc. The PDL applies only to drugs you get at retail and specialty pharmacies. Health plans available through Medicaid and HealthSource RI both offer a similar set of important benefits, called essential health benefits. �1�3�2ڰ�c\ø�1���5�Ig��� �����o��.�E���_��C��O}/�d`���y��p���XN� �M0fr���Ĝ��)��Q�����t��a`Rn�a`�� ˷0���1@� T�q In each class, drugs are listed alphabetically by either brand name or generic name. Oregon Health Plan Preferred Drug List, a list of the most cost-effective drugs to prescribe for fee-for-service members. NC Medicaid and Health Choice Preferred Drug List (PDL) effective Jan. 1, 2020 RHODE ISLAND. 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