Pharmacy information

Requirements for professional and outpatient institutional claims containing physician administered drugs:

UniCare Health Plan of West Virginia, Inc. (UniCare) will deny professional and outpatient institutional claims containing physician-administered drugs if any of the following elements are missing or invalid:

• NDC*
• Unit of measurement
• Quantity of drug

*The NDC is an 11-digit code on the package or container from which medication is administered.

National Drugs Codes (NDCs)

Providers must include national drug codes (NDCs), unit of measurement and quantity of drug on all UniCare claims, including physician-administered drugs. This applies to drugs dispensed in both professional and institutional outpatient settings.

West Virginia’s BMS requires that UniCare report NDC information every month. BMS submits this data to pharmaceutical manufacturers to obtain rebates under the Medicaid Drug Rebate Program. Following these instructions is important for West Virginia to receive timely Medicaid Drug Rebates from drug manufacturers.

Pharmacy PDL inquiries

The PDL is part of the pharmacy service provided by BMS and is located on the Preferred Drug List page  of the BMS website .

Outpatient infusion pharmaceuticals

Billing requirements for outpatient infusion pharmaceuticals apply to drugs such as chemotherapy, hydration and antibiotics used during each outpatient infusion therapy visit. An important exception is for blood and blood products, which are billed under the Other Services category. Specific codes and service dates are required; guidance for relevant billing and HCPCS codes can be found in the Provider Manual .

Related pharmacy resources

For prior authorization requirements specific to pharmaceuticals including specialty medications, please visit the Prior Authorization Requirements page .