Does Medicaid cover prescriptions in West Virginia?
The West Virginia Medicaid Pharmacy Program is an optional fee-for-service benefit offered to all eligible members, including those who are enrolled in Medicaid Managed Care plans. In Calendar Year 2014, WV Medicaid reimbursed more than 6.5 million prescription claims for a total of over $377.6M.
What medications does Medicaid not cover?
Drugs excluded from Medicare coverage by law that may be covered by your state’s Medicaid program include:
- Drugs for: Anorexia, weight loss, or weight gain. Fertility.
- Prescription vitamins and minerals (except prenatal vitamins and fluoride preparations)
- Non-prescription drugs (over-the-counter drugs)
What is covered under WV Medicaid?
West Virginia Medicaid covers family planning and counseling, pregnancy tests, STI tests, sterilization, and gynecologist services such as pap smears, birth control visits, and lab tests. Maternity care including prenatal, delivery and postpartum care (including newborn doctor services) are all included as well.
What is Medicaid prescription?
Although pharmacy coverage is an optional benefit under federal Medicaid law, all states currently provide coverage for outpatient prescription drugs to all categorically eligible individuals and most other enrollees within their state Medicaid programs.
What specialty pharmacy does WV Medicaid use?
THP and CoventryCares of WV utilize a specialty drug list. THP and CoventryCares members must fill prescriptions for drugs on the specialty list using the respective MCO’s preferred specialty provider, which is currently Accredo.
How do I check my Medicaid status in WV?
You may call Provider Services at (888)-483-0793 or (304) 348-3360 to check if a claim has been received. Please have your ten-digit WV Medicaid provider number, the patient’s eleven digit Medicaid number, the date/s of service and the billed amount when calling Provider Services to check claim status.
Can Medicaid patients pay cash for prescriptions?
If you have notified us, you may accept cash for current patients for one full prescription while we work with the prescriber.
Will Medicaid pay for prescriptions if I have Medicare?
When you become eligible for both Medicare and Medicaid you will automatically be assigned to a Medicare Prescription Drug Plan to make sure you don’t miss a day of coverage. You can also enroll in a plan of your own choosing that may better meet your prescription drug needs.
What is the cut off for Medicaid WV?
Who is eligible for West Virginia Medicaid?
| Household Size* | Maximum Income Level (Per Year) |
|---|---|
| 1 | $17,131 |
| 2 | $23,169 |
| 3 | $29,207 |
| 4 | $35,245 |
What is income limit for Medicaid in WV?
Annual Household Income Limits (before taxes)
| Household Size* | Maximum Income Level (Per Year) |
|---|---|
| 1 | $17,131 |
| 2 | $23,169 |
| 3 | $29,207 |
| 4 | $35,245 |
How much are prescriptions with Medicaid?
States establish dispensing fees for the pharmacies that fill prescriptions for Medicaid beneficiaries. In most states, these fees typically range between $9 and $12 for each prescription.
What are preferred drug lists?
A Preferred Drug List (PDL) is a list of outpatient drugs that states encourage providers to prescribe over others, as a mechanism to negotiate higher supplemental rebates. A state may attach a higher copay or require prior authorization for drugs not on the PDL.
How many prescriptions are covered by West Virginia Medicaid?
In Calendar Year 2014, WV Medicaid reimbursed more than 6.5 million prescription claims for a total of over $377.6M. Most prescription and some over-the-counter medications are covered as defined by federal law and regulations. The Pharmacy Program uses a Preferred Drug List with criteria established for non-preferred products.
What is the preferred drug list in West Virginia?
The Preferred Drug List (PDL) is a medication list recommended to the Bureau for Medical Services by the Medicaid Pharmaceutical and Therapeutics (P & T) Committee and approved by the Secretary of the Department of Health and Human Resources, as authorized by West Virginia Code ยง9-5-15.
How to apply for Medicaid in West Virginia?
If you are not already enrolled, please visit the West Virginia Medicaid claims processor’s, Molina Medicaid Solutions, website at: https://www.wvmmis.com and enroll online as a billing provider or as an “ORP Only Provider.” The quickest enrollment option is the ORP-Only online application process.
How to contact Molina pharmacy in West Virginia?
For questions, please contact Gainwell Technology Provider Enrollment at 888-483-0793 or the Molina Pharmacy Help Desk at 888-483-0801. The West Virginia Medicaid Pharmacy Program is an optional fee-for-service benefit offered to all eligible members, including those who are enrolled in Medicaid Managed Care plans.