Welcome to the Pharmacy page for the Colorado Medical Assistance Program. This site contains helpful information for Medical Assistance Program providers and other interested parties. It also provides links to other valuable information.
Please continue to check the Pharmacy sections for updated information about the Colorado Medical Assistance Program.
Copay Exemption Update
Effective January 1, 2014, all preventative and wellness services as required by the Affordable Care Act are copay exempt. The outpatient drugs which qualify as preventative services include aspirin and Vitamin D. The pharmacy claims system is currently unable to apply the copay exemption to claims for these drugs. As a result, the Department requests that pharmacy providers do not collect the copay from Medicaid clients for these drugs. Once the copay exemption has been implemented in the pharmacy claims system, the Department will mass adjust the claims for aspirin and Vitamin D so that pharmacies will be reimbursed for the uncollected copays. If you have any questions, please contact the Pharmacy Liaison at 303-866-3588.
Cost of Dispensing Prescription Drugs by 340B Entities to Medicaid Clients
The Department contracted with Mercer Government Human Services Consulting (Mercer) to study the cost of dispensing prescription medications to Medicaid clients by entities that participate in the 340B Program. To view the report prepared by Mercer please click here.
If you have any questions or comments related to the report, please send them to Colorado.SMAC@state.co.us
Coordination of Benefits (COB) Manager
The Department of Health Care Policy and Financing (Department) will be implementing COBManager during the second week of April 2013. This new tool will ensure that commercial coverage pays first when a Medicaid client also has commercial pharmacy coverage.
HMS, a vendor of the Department, will receive pharmacy claims on a daily basis and will search its eligibility database to see if there is other coverage. If there is other coverage, HMS will submit the claim to the commercial PBM as if the claim came from the pharmacy. If the claim is successfully adjudicated, an adjustment is sent to the Department in the form of a “rebill” claim showing the amount paid by the commercial PBM.
Providers can search for activity or download transactions affected by COBManager through a secured HMS web portal “eCenter.” You may contact HMS for access or for information regarding eCenter by calling 855-438-6420. HMS staff will provide you the necessary information to log into the eCenter Web portal. Please see the links below for further information regarding COBManager.
HMS secured web portal: https://ecenter.hmsy.com
HMS Provider Relations: 855-438-6420