Find a Pharmacy that takes Medicaid
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. The 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.
Pharmacists can bill Medicaid and provide services
Seeing a doctor to get contraception and HIV preventative medications can be a burden for Medicaid members. Now, they no longer have to. They can come directly to you for some services without a prescription.
During the 81st Nevada Legislative Session (2021), Senate Bill (SB) 190 and SB325 passed allowing pharmacist to provide and be reimbursed for services related to self-administered hormonal contraceptives and the prevention acquisition of Human Immunodeficiency Virus (HIV).
On July 7, 2022, the Centers for Medicare, and Medicaid Services (CMS) approved Nevada Medicaid’s State Plan Amendment to include pharmacist as a new provider type. Since then, Nevada Medicaid has implemented a new provider type (PT) 91 – Pharmacist and established Medicaid policy surrounding pharmacist-provided services.
Please share the flyers below with the public (by posting) and pharmacy staff.
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.