Provider Documents

Manuals, payer specs, newsletters and more!

Provider Directory DATE ADDED
Link to Kentucky Medicaid Provider DirectoryKentucky Medicaid Provider Directory 06/16/2021
Payer Specs DATE ADDED
Download PDF - Kentucky Medicaid D.0 Payer Specs Kentucky Medicaid D.0 Payer Specs 07/21/2022
Download PDF - Emergency Preparedness Pharmacy Communications Emergency Preparedness Pharmacy Communications 12/12/2021
Drug Information DATE ADDED
Link to Preferred Drug List (PDL) Preferred Drug List (PDL) 06/15/2021
Download PDF - Over-the-Counter (OTC) Drug List Over-the-Counter (OTC) Drug List 01/21/2022
Link to Maximum Quantity Limits List Maximum Quantity Limits List 06/15/2021
Link to Prior Authorization (PA) Criteria Prior Authorization (PA) Criteria 06/15/2021
Link to Diabetic Supplies Preferred Drug ListDiabetic Supplies Preferred Drug List 06/29/2021
Download PDF - Kentucky Medicaid Vaccine List (effective 9/2/2022) Kentucky Medicaid Vaccine List (effective 9/2/2022) 07/28/2022
Download PDF - Aduhelm - Prescriber Administered Drug Prior Authorization Criteria Aduhelm - Prescriber Administered Drug Prior Authorization Criteria 04/08/2022
Download PDF - Kentucky Medicaid Pharmacy Injectable Drug List Kentucky Medicaid Pharmacy Injectable Drug List 09/20/2022
Pharmacy and Therapeutics (P&T) Advisory Committee - Link to CHFS Committee Website DATE ADDED
Link to Pharmacy and Therapeutics Advisory Committee - Cabinet for Health and Family Services (ky.gov)Pharmacy and Therapeutics Advisory Committee - Cabinet for Health and Family Services (ky.gov) 08/04/2022
Manuals DATE ADDED
Download PDF - Provider Billing Manual Provider Billing Manual 09/07/2021
Provider Notices & Newsletters DATE ADDED
Download PDF - Lidocaine Patch PDL Update Lidocaine Patch PDL Update 02/02/2023
Download PDF - Extension of Temporary PDL Changes Due To Shortages Extension of Temporary PDL Changes Due To Shortages 01/23/2023
Download PDF - Immune Globulin (IVIG/SCIG) Criteria Change Immune Globulin (IVIG/SCIG) Criteria Change 12/09/2022
Download PDF - Brand/Generic Insulin Changes Brand/Generic Insulin Changes 11/21/2022
Download PDF - Provider Notice Injectable Drug List Provider Notice Injectable Drug List 04/08/2022
Download PDF - COVID-19 Testing Physician Protocol - Updated COVID-19 Testing Physician Protocol - Updated 01/31/2022
Download PDF - COVID-19 Testing Physician Protocol/Standing Order COVID-19 Testing Physician Protocol/Standing Order 01/28/2022
Download PDF - Provider Notice Covid-19 Test Kits Provider Notice Covid-19 Test Kits 01/28/2022
Download PDF - Pharmacy Newsletter, October 2021 Pharmacy Newsletter, October 2021 11/29/2021
Download PDF - Provider Mailing June 21, 2021 Provider Mailing June 21, 2021 09/07/2021
Download PDF - Provider SB 51 Notice June 10, 2021 Provider SB 51 Notice June 10, 2021 06/16/2021
Link to Provider Pharmacy Program NoticeProvider Pharmacy Program Notice 06/16/2021
Link to Pharmacy 835 Communication June 8, 2021Pharmacy 835 Communication June 8, 2021 06/15/2021
Link to Provider Mailing June 1, 2021Provider Mailing June 1, 2021 06/15/2021
Link to Provider Mailing May 1, 2021Provider Mailing May 1, 2021 06/15/2021
Link to Provider Mailing April 1, 2021Provider Mailing April 1, 2021 06/15/2021
Download PDF - Provider Notice Paxlovid Protocol Provider Notice Paxlovid Protocol 08/16/2022
Member Notices DATE ADDED
Link to Aetna Pharmacy Program Member NoticeAetna Pharmacy Program Member Notice 06/16/2021
Link to Anthem Pharmacy Program Member NoticeAnthem Pharmacy Program Member Notice 06/16/2021
Link to Humana Pharmacy Program Member NoticeHumana Pharmacy Program Member Notice 06/16/2021
Link to Passport Pharmacy Program Member NoticePassport Pharmacy Program Member Notice 06/16/2021
Link to UnitedHealthcare Pharmacy Program Member NoticeUnitedHealthcare Pharmacy Program Member Notice 06/16/2021
Link to WellCare Pharmacy Program Member NoticeWellCare Pharmacy Program Member Notice 06/16/2021
340B Process for Covered Entities DATE ADDED
Link to Link to 340B Process Documentation on DMS WebsiteLink to 340B Process Documentation on DMS Website 02/22/2022
Download PDF - 340B Cover Letter 340B Cover Letter 02/17/2022
Download PDF - 340B FAQs 340B FAQs 02/25/2022
Download PDF - 340B Non Participation Notice Form 340B Non Participation Notice Form 02/25/2022
Download PDF - 340B Participation Notice Form 340B Participation Notice Form 02/25/2022