Medicaid is a joint federal and state health care program that pays for medical costs for people with limited income and resources. The Division of Health Care Financing and Policy (DHCFP), Nevada Medicaid, reimburses pharmacies and practitioners for FDA approved prescriptions and certain over-the-counter drugs dispensed or administered to Medicaid recipients. Some covered drugs (not on the non-covered list) may be subject to prior authorization requirements or quantity limitations. DHCFP contracts with a Pharmacy Benefit Manager (PBM) to provide Point of Sale (POS) adjudication at the pharmacy counter for pharmacy claims.
For more information, see the link for the Nevada Medicaid Services Manual (MSM) Chapter 1200 on the right.
Emergency Supply Policy
If the prescriber is not available and the pharmacist feels the recipient needs to receive the prescribed drug, the pharmacist should contact the Clinical Call Center at: (855) 455-3311. OptumRx may authorize a 96-hour emergency supply.
NOTE: An emergency situation is a situation that, in the judgment of the dispensing pharmacist, involves an immediate threat of severe adverse consequences to the recipient, or the continuation of immediate and severe adverse consequences to the recipient, if an outpatient drug is not dispensed when a prescription is submitted.