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Pharmacy Benefit Management
In an effort to reduce Medicaid spending while still ensuring access to quality care, the Department of Health and Human Services (DHHS) has implemented the NH Medicaid Pharmacy Benefit Program initiatives outlined below.

The Preferred Drug List (PDL) is a list of effective prescription drugs within therapeutic drug classes. These drugs are the recommended first choice when prescribing for Medicaid patients.

The Clinical Prior Authorization (PA) Program was implemented to improve quality and manage drug classes that have been identified as requiring additional monitoring. This program is also intended as a means of ensuring that drugs are being prescribed for the right patients and for the appropriate reasons, while still monitoring drug expenditures.

Medicaid covers certain over the counter drugs that are medically necessary. Only generic versions of certain over the counter drugs are covered. All cough and cold preparations are non-covered.

A quantity limit is the maximum allowable quantity of a drug that may be dispensed per prescription per date of service or per month. Quantity limits are applied to medications when the majority of appropriate clinical utilizations will be addressed within the quantity allowed.

The Maximum Allowable Cost (MAC) List provides the NH Medicaid pricing for multi source generic drugs. The MAC list is updated weekly and managed by Magellan Medicaid Administration. This is a secure site and you must be a registered user to access.

Notices regarding compliance with the federally mandated Medicaid Tamper Resistant Prescription requirements.

Maintenance medications are those pharmaceuticals that have been previously prescribed for the recipient for the treatment of chronic diseases. Treatment must have been for continuous daily therapy of at least 120 days duration.

Notices are sent to NH Medicaid enrolled providers to inform them of important information regarding the Medicaid Pharmacy Program.

Medicaid Care Management (MCM) Prescription Drug Information

The links below will take you directly to the prescription drug lists for the three Managed Care Organizations (MCO) participating in the MCM program. Questions and requests for further information should be referred directly to the individual MCO.

 

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New Hampshire Department of Health and Human Services
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