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Mail Order Prescriptions

Qualifying Medicaid fee-for-service clients may receive their outpatient maintenance medications from mail order pharmacies.

 

In order to qualify, a Medicaid client must have:

  1. A physical hardship that prohibits him or her from obtaining their maintenance medications from a local pharmacy; or
  2. Third party insurance that allows the use of a mail order pharmacy to obtain their maintenance medications.

 

A client, or the client's physician, must complete and submit an enrollment form to the Department that attests the client meets the one of the qualifying criteria.

 

If a mail order pharmacy submits a pharmacy claim for a Medicaid client that has not enrolled for the mail order benefit, the claim will be denied.  The NCPDP edit that will appear at the point-of-sale is an 85, with text indicating that the claim did not process.  This denial will appear as edit PB85 on the Provider Claim Report, with information indicating the claim did not process.  Please contact the Help Desk at 1-800-365-4944 if you have any questions about denied pharmacy claims.

 

Out-of-state mail order pharmacies are permitted to enroll as Medicaid providers but may only mail maintenance medications to clients who have applied for the mail order pharmacy benefit.  Click here for more information on how to enroll as a Medicaid provider. 

 

Local pharmacies, which are not mail order pharmacies, may continue to occasionally mail any type of outpatient medication to any fee-for-service Medicaid clients without the clients having to enroll for the mail order pharmacy benefit.

 

 

Enrollment

 

Mail Order Prescription Application 

 

Please email or fax the completed enrollment application to:

 

Colorado Department of Health Care Policy and Financing

Pharmacy Benefits Section

1570 Grant Street

Denver, CO 80203-1818

Fax:  303-866-3590

 

If you have any questions, please contact Chris Ukoha.