Traditional MedicareAdministrativeHigh impact
Medicare Part D Drug Coverage and Pharmacy Benefit Changes in the Medicaid and Maryland Pharmacy Program
Maryland Medicaid·MD · Pharmacy·Pharmacy
Effective date
Jan 1, 2006
We identified it
Jun 20, 2026
Summary
Medicare Part D prescription drug benefit will replace Maryland Pharmacy Program as the primary payer for prescription medications for Medicare-eligible recipients starting January 1, 2006. Pharmacies must bill Medicare Prescription Drug Plans (PDPs) instead of Medicaid for covered drugs, with Medicaid only covering specific excluded medications like barbiturates and benzodiazepines.
Action Required
By January 1, 2006: Billing team must update pharmacy billing systems to bill Medicare Prescription Drug Plans (PDPs) instead of Medicaid for Medicare Part D covered drugs for dual-eligible recipients. Update billing software to identify PDP enrollment for each recipient. For rejected claims due to non-formulary drugs, contact the specific PDP for preauthorization rather than billing Medicaid. Continue billing Medicaid only for excluded drugs: barbiturates, benzodiazepines, legend vitamins, and legend cough/cold preparations. Claims billed to Medicaid for Part D covered drugs will be rejected with message to bill Medicare.