Payer Sheets - Version D.0
Specifications for online claims processing/NCPDP.
B1, B2, B3 (Revised December 2022)
Instructions for 340b pharmacies are within the payer sheet. 340b contract pharmacies must carve out ND Medicaid. For Medicaid Managed Care, providers are not allowed to use 340b products. Pharmacy services are carved out of managed care starting 1/1/2020.
Pharmacy Prior Authorization Info and Forms
Kepro is North Dakota Medicaid's Prior Authorization Vendor. Per federal law, state Medicaid programs may require, as a condition of coverage or payment for a covered outpatient drug, the prior approval of the drug before it is dispensed for any medically accepted indication.
The 2003 Legislative Assembly passed House Bill 1430. This restructured the existing Drug Use Review (DUR) Board and required the Board to advise the Department of Human Services in developing a Prior Authorization (PA) process to help assure that beneficiaries receive appropriate medications in the most cost-effective manner, thus conserving state expenditures for drugs whenever possible.
Questions? Contact Brendan Joyce, PharmD, Administrator, Pharmacy Services at bjoyce@nd.gov .
Drug Rebate Program
Resources
Additional Links
- Visit: website ND Board of Pharmacy
- Visit website: Centers for Medicare and Medicaid Services: Medicaid Prescription Drug
Questions? Contact Us
If you have pharmacy questions, you may e-mail them to dhsmed@nd.gov. If you have pharmacy billing questions, contact provider relations at (701) 328-7098.