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BAM 402 5 of 20 MA BENEFITS BPB 2021-026 10-1-2021

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

MICHIGAN PHARMACEUTICAL BEST PRACTICES MA MDHHS has contracted with Magellan Medicaid Administration, Inc. to be the pharmacy benefits manager for its fee-for-service health programs and pregnancy-related pharmacy services for Maternity Outpatient Medical Services (MOMS) beneficiaries. The pharmacy benefits manager is responsible for all of the following: • Prior authorizing certain drugs. • Processing pharmacy claims. • Approving payment to pharmacies. • Other administrative functions to ensure that appropriate payments are being made. Magellan Medicaid Administration, Inc. does not prior authorize or pay claims for Medicaid contracted health plans. Prior Authorization Drugs that require prior authorization appear on the Michigan Phar- maceutical Products List (MPPL). Physicians or other prescribers may request prior authorization by contacting First Health Services. Magellan Medicaid Administration, Inc. MAP Department 4300 Cox Road Glenn Allen, VA 23060 Telephone: 1-877-864-9014 Fax: 1-888-603-7696 or 1-800-250-6950 Hearing Rights A beneficiary is notified in writing within 10 calendar days of a prior authorization denial. The notice tells the beneficiary how to apply for a MDHHS administrative hearing. The MDHHS hearings application form and a stamped envelope are included with the notice.

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Page 5

Official source

BAM 402 5 of 20 MA BENEFITS BPB 2021-026 10-1-2021

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

MICHIGAN PHARMACEUTICAL BEST PRACTICES MA MDHHS has contracted with Magellan Medicaid Administration, Inc. to be the pharmacy benefits manager for its fee-for-service health programs and pregnancy-related pharmacy services for Maternity Outpatient Medical Services (MOMS) beneficiaries. The pharmacy benefits manager is responsible for all of the following: • Prior authorizing certain drugs. • Processing pharmacy claims. • Approving payment to pharmacies. • Other administrative functions to ensure that appropriate payments are being made. Magellan Medicaid Administration, Inc. does not prior authorize or pay claims for Medicaid contracted health plans. Prior Authorization Drugs that require prior authorization appear on the Michigan Phar- maceutical Products List (MPPL). Physicians or other prescribers may request prior authorization by contacting First Health Services. Magellan Medicaid Administration, Inc. MAP Department 4300 Cox Road Glenn Allen, VA 23060 Telephone: 1-877-864-9014 Fax: 1-888-603-7696 or 1-800-250-6950 Hearing Rights A beneficiary is notified in writing within 10 calendar days of a prior authorization denial. The notice tells the beneficiary how to apply for a MDHHS administrative hearing. The MDHHS hearings application form and a stamped envelope are included with the notice.