Welcome to the Wisconsin Medicaid
Pharmacy Handbook

Revised October 2004

Effective immediately, Wisconsin Medicaid will no longer mail quarterly revisions to the data tables on CD or paper. Changes and additions to the data tables and the PDL will now be included on the pharmacy service-specific Web page on the Medicaid Web site at dhs.wisconsin.gov/medicaid/.

The following data tables will be published monthly to the Medicaid Pharmacy Web page. Effective dates for these tables will be the first of each month:

• Brand medically necessary drugs.
• Diagnosis-restricted drugs.
• Legend Drug Maximum Allowable Cost (MAC) drugs.
• Prior authorization drugs.
• Over-the-counter MAC drugs.
• Preferred Drug List.

The following data tables will be published quarterly to the Medicaid Pharmacy Web page. Effective dates for these tables will be January 1, April 1, July 1, and October 1.

• Health Check "Other Services" covered by Wisconsin Medicaid without PA.
• Less-than-effective/Identical, Related, or Similar drugs.
• Manufacturers that have signed rebate agreements.
• Wisconsin Medicaid Noncovered Drugs — Manufacturer Rebates Refused.

Providers should check the Wisconsin Medicaid Web site the first of each month for any changes to the data tables.

Each month, a list of the revised data tables will be provided in the "What’s new on the Web" section of the Update Summary.

Providers who do not have Internet access can contact Provider Services at (800) 947-9627 or (608) 221-9883 to obtain paper copies of the PDL, the PDL implementation schedule, and data tables as they are revised. Policy changes will continue to be issued in Updates.

Wisconsin Medicaid Pharmacy Handbook
October 2004