Pharmacy Providers

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Payer Sheets - Version D.0

Specifications for online claims processing/NCPDP:

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 January 1, 2020.

Pharmacy Prior Authorization Info and Forms

Acentra Health 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 Health & 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 .

Naloxone Standing Order

This Standing Order, issued pursuant to North Dakota Century Code § 23-01-42, authorizes North Dakota Medicaid enrolled pharmacies to dispense any over-the-counter naloxone product covered by North Dakota Medicaid to eligible North Dakota Medicaid members.

Naloxone Standing Order