Pharmacy

Data Tables

• Archived Data Tables
   
• 100-Day Supply
  (Effective 11/07)
  Other formats: PDF (18 KB) or Excel (27 KB)
   
• BadgerCare Plus Benchmark NDC List
  (Effective 5/1/08)
  Formats: PDF (1750 KB) or Excel (1183 KB)
   
• BadgerCare Plus-Covered Drug-Related Supplies
  (Effective 2/1/08)
  Other formats: PDF (55 KB) or Excel (22 KB)
   
• Brand Medically Necessary Drugs That Require Prior Authorization
  (Effective 5/1/08)
  Other formats: PDF (117 KB) or Excel (35 KB)
   
• Diagnosis Restricted Drugs
  (Effective 5/1/08)
  Other formats: PDF (81 KB) or Excel (45 KB)
   
• HealthCheck "Other Services" Covered by Wisconsin Medicaid Without Prior Authorization
  (Effective 7/07)
  Other formats: PDF (30 KB) or Excel (31 KB)
   
• Legend Drug Maximum Allowed Cost List
  (Effective 5/1/08)
  Other formats: PDF (504 KB) or Excel (578 KB)
   
• Less-Than-Effective/Identical, Related, or Similar Drugs
  (Effective 4/1/08)
  Other formats: PDF (40 KB) or Excel (35 KB)
   
• Noncovered Drugs — Manufacturer Rebates Refused
  (Effective 7/06)
  Other formats: PDF (78 KB) or Excel (64 KB)
   
• Numeric Listing of Manufacturers That Have Signed Rebate Agreements
  (Effective 4/1/08)
  Other formats: PDF (108 KB) or Excel (76 KB)
   
• Over-the-Counter Maximum Allowed Cost List
  (Effective 5/1/08)
  Other formats: PDF (76 KB) or Excel (31 KB)
   
• Quantity Limits
  (Effective 4/2/08)
  Other formats: PDF (14 KB) or Excel (19 KB)

Archived Data Tables

Cover memorandums from previous Data Table releases.

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Wisconsin Department of Health and Family Services
Protecting and promoting the health and safety of the people of Wisconsin