Pharmacy
Gainwell Technologies is the Single Pharmacy Benefit Administrator (SPBA) for the Mississippi Division of Medicaid (DOM) pharmacy program. All TrueCare members receive pharmacy benefits through the SPBA.
TrueCare continues to provide coverage for provider administered drugs under the medical benefit.
Single Pharmacy Benefit Administrator Pharmacy Benefits
Gainwell Technologies covers all Medicaid-covered, medically necessary prescriptions, certain over the counter (OTC) medications, vaccines, and select durable medical equipment.
Preferred Drug List (PDL)
TrueCare will post a link to the Preferred Drug List (PDL) maintained by Gainwell Technologies. It will include the Drug Formulary and PDL preferred products, in addition to preferred products in categories outside of the SUPDL. Visit the Drug Formulary page for more information.
Prior Authorization
Some drugs may require prior authorization before they will be covered. Refer to the PDL to determine which drugs need prior authorization.
Physician administered drugs billed under a member’s medical benefit may also require prior authorization.
For all prior authorization decisions (standard or urgent), TrueCare provides notice to the physician and member as expeditiously as the member’s health condition requires. Please specify if you believe the request is urgent and include all necessary clinical documentation to support expeditious review.
Medical Benefit Fax | 888-399-0271 |
A Specialty Pharmacy Prior Authorization Request Form is available on the Forms webpage to support prior authorization submission for physician administered medications. | |
Note: Prior authorization requests for physician-administered medications covered under the medical benefit may be submitted via electronic submission: TrueCare provider portal or fax to 1-888-399-0271. | |
Policies
TrueCare pharmacy and medical policies include drug specific and therapy class policies to be used as a guide when determining health care coverage for our members.
The policies are written for those that are non-preferred, preferred with prior authorization or require step therapy. The policy is a tool to be interpreted in conjunction with the member’s specific benefit plan. Access pharmacy policies by selecting “Policies” from the Quick Links for more information.
Beneficiary Health Management Program (BHMP)
BHM is a health and safety program which protects members whose use of services exceed medical necessity. Members are identified and confirmed through analysis and audit by the Pharmacy Department and will be restricted to only one specific pharmacy for a defined period of time. Questions about the program should be directed to TrueCare Member Services at 1-833-230-2050.
Drug Safety Recalls
Sometimes, a drug manufacturer or the federal government issues drug recalls. To find out if a drug you have prescribed to a patient is being recalled, please check the listings on the FDA website.