Coverage & Reimbursement
Welcome to the Coverage & Reimbursement page for the Utah Medicaid Pharmacy Program. Come back often to browse our library of Medicaid Coverage & Reimbursement Policy Manuals and bulletins.
Reimbursement schedules for HCPCS codes can be found here
Utah MAC (Maximum Allowable Cost) Update:
Historically, Utah has enjoyed a state MAC (state maximum allowable charge) price as well as a Federal MAC price. Medicaid is actively updating the state MAC list. Among other methodologies, Medicaid will compare the posted MAC prices from eight other states including five western states. New MAC prices will be posted to the point-of-sale program as they are determined.
Pharmacy providers may contact Medicaid if they find MAC prices are set below acquisition costs after discounts are factored in. An invoice for the most recent purchase of the drug in question must be FAXed to Medicaid when any grievance is initiated.
New MAC prices may include but not be limited to the agents listed on the Utah MAC list in the library below
The documents are provided in Adobe format. If you cannot view a file, please download the free plug-in from the link below.
Click here to view current Medicaid Provider ManualsClick here to view current Medicaid Information Bulletins (MIBs)
| Name | Type | Last Modified |
| Medicare Drug Coverage Tip Sheet.pdf | October 04, 2007 | |
| OTC LIST 7-10.pdf | December 28, 2011 | |
| Tamper Resistant NCPDP letter.pdf | December 28, 2011 | |
| Utah_Medicaid_Dispensing_Fee_Schedule.pdf | May 04, 2009 | |