Forms & Documents - New Hampshire

Forms and Documents

CMS Tamper Resistant Prescription Pad Implementation

0.01 MB Mar 10' 2023

CMS Tamper Resistant Prescription Pad Law_FAQ

0.03 MB Mar 10' 2023

CMS Tamper Resistant Prescription Pad Law_Pharmacist Fact Sheet

0.04 MB Mar 10' 2023

CMS Tamper Resistant Prescription Pad Law_Pharmacist Info

0.03 MB Mar 10' 2023

CMS TRPP State Medicaid Director Letter

0.08 MB Mar 10' 2023

DUR Agenda 03.20.2017

0.3 MB Mar 13' 2023

DUR Agenda 05.12.2015

0.04 MB Mar 13' 2023

DUR Agenda 05.20.2014

0.06 MB Mar 13' 2023

DUR Agenda 05.31.2016

0.09 MB Mar 13' 2023

DUR Agenda 10.11.2016

0.09 MB Mar 13' 2023

DUR Agenda 10.24.2017

0.44 MB Mar 13' 2023

Notification 01.09.2015 PDL-Clinical PA Updates-Web Portal Info-Email

0.03 MB Mar 13' 2023

Notification 01.10.2017 PDL-Clinical PA Updates-Web Portal Info-Email

0.03 MB Mar 13' 2023

Notification 04.02.2013 Change in TPL Field Length

0.03 MB Mar 13' 2023

Notification 05.17.2012 PDL-Clinical PA Updates-Web Portal Info-Email

0.03 MB Mar 13' 2023

Notification 05.26.2017 Updated Fiscal Impact Regarding Outpatient Drug Rule

0.01 MB Mar 13' 2023

Notification 06.16.2017 PDL-Clinical PA Updates-Web Portal Info-Email

0.18 MB Mar 13' 2023

Notification 07.03.2014 Changes to Copay

0.03 MB Mar 13' 2023

Notification 07.20.2016 PDL-Clinical PA Updates-Web Portal Info-Email

0.03 MB Mar 13' 2023

Notification 07.25.2012 PDL-Clinical PA Updates-Web Portal Info-Email

0.03 MB Mar 13' 2023

Notification 08.01.2014 PDL-Clinical PA Updates-Web Portal Info-Email

0.13 MB Mar 13' 2023

Notification 08.04.2013 PDL-Clinical PA Updates-Web Portal Info-Email

0.03 MB Mar 13' 2023

Notification 08.22.2012 Diabetic Supply Program Update

0.03 MB Mar 13' 2023

Notification 08.24.2015 PDL Transition

0.02 MB Mar 13' 2023

Notification 08.24.2015 PDL-Clinical PA Updates-Web Portal Info-Email

0.04 MB Mar 13' 2023

Notification 10.08.2017 Emergency Drug Coverage Reminder

0.1 MB Mar 13' 2023

Notification 10.30.2014 NHHPP Reinstatement of Co-Pays

0.05 MB Mar 13' 2023

Notification 12.06.2012 Benzodiazepines and Barbiturates in Dual Eligibles

0.03 MB Mar 13' 2023

Notification 12.07.2012 Diabetic Supply Program

0.04 MB Mar 13' 2023

Notification 12.15.2017 PDL-Clinical PA Updates-Web Portal Info-Email

0.17 MB Mar 13' 2023

Adenosine Triphosphate-Citrate Lyase Criteria

0.17 MB Mar 10' 2023

Allergen Extract Criteria

0.17 MB Mar 10' 2023

Antifungal for Onychomycosis Criteria

0.27 MB Mar 10' 2023

Asthma-Allergy Immunomodulator Criteria

0.26 MB Mar 13' 2023

Bowel Disorders.GI Motility, Chronic Criteria

0.24 MB Mar 13' 2023

BPH Criteria

0.17 MB Mar 10' 2023

Brand Name Multisource Drug Criteria

0.14 MB Mar 10' 2023

Buprenorphine-Naloxone and Buprenorphine (Oral) Criteria

0.19 MB Mar 13' 2023

Carisoprodol and Combination Criteria

0.15 MB Mar 10' 2023

CGRP Inhibitor Criteria

0.19 MB Mar 10' 2023

CNS Stimulants (ADHD.ADD) Criteria

0.25 MB Mar 13' 2023

Codeine for Pediatric Use Criteria

0.15 MB Mar 10' 2023

Convenience Kits Criteria

0.14 MB Mar 10' 2023

Duchenne Muscular Dystrophy Agents Criteria

0.2 MB Mar 10' 2023

Duloxetine Criteria

0.27 MB Mar 10' 2023

Dupixent Criteria

0.18 MB Mar 10' 2023

Fibromyalgia Criteria

0.15 MB Mar 10' 2023

Hematopoietic Agent Criteria

0.18 MB Mar 10' 2023

Hepatitis C Criteria

0.37 MB Mar 10' 2023

Hetlioz Criteria

0.18 MB Mar 10' 2023

Horizant Criteria

0.14 MB Mar 10' 2023

Human Growth Hormones Criteria

0.24 MB Mar 10' 2023

Hyaluronic Acid Derivatives Injection Criteria

0.18 MB Mar 10' 2023

Inhaled Insulin Criteria

0.17 MB Mar 10' 2023

Juxtapid Criteria

0.15 MB Mar 10' 2023

Long-acting Opioid Analgesic Criteria

0.17 MB Mar 10' 2023

Methadone Criteria

0.17 MB Mar 10' 2023

Monoclonal Antibody for Alzheimer's Criteria

0.19 MB Mar 10' 2023

Morphine Milligram Equivalent (MME) Criteria

0.15 MB Mar 10' 2023

Movement Disorders Criteria

0.21 MB Mar 10' 2023

New Drug Product Criteria

0.15 MB Mar 10' 2023

Oral Isotretinoin Criteria

0.15 MB Mar 10' 2023

PCSK9 Criteria

0.18 MB Mar 10' 2023

Pregabalin Criteria

0.16 MB Mar 10' 2023

Psychoactive Meds for Children under 5 Criteria

0.14 MB Mar 10' 2023

Psychotropic Meds Duplicate Therapy Peds 6 and above Criteria

0.17 MB Mar 10' 2023

Pulmonary Arterial Hypertension PDE-5 Criteria

0.18 MB Mar 10' 2023

Rho Kinase Inhibitor Criteria

0.15 MB Mar 10' 2023

Second-Line Antifungal Criteria

0.2 MB Mar 10' 2023

Short-Acting Fentanyl Criteria

0.16 MB Mar 10' 2023

Skin Disorders Criteria

0.26 MB Mar 10' 2023

Skysona Criteria

0.17 MB Mar 10' 2023

Spinal Muscular Atrophy Criteria

0.23 MB Mar 10' 2023

Spravato Criteria

0.19 MB Mar 10' 2023

Stromectol Criteria

0.14 MB Mar 10' 2023

Symlin Criteria

0.15 MB Mar 10' 2023

Synagis Criteria

0.16 MB Mar 10' 2023

Systemic Immunomodulator Criteria

0.27 MB Mar 10' 2023

Verquvo Criteria

0.16 MB Mar 10' 2023

Vuity Criteria

0.15 MB Mar 10' 2023

Weight Management Criteria

0.2 MB Mar 20' 2023

Zynteglo Criteria

0.19 MB Mar 10' 2023

Agenda 03.12.2019

0.14 MB Mar 13' 2023

Agenda 05.03.2018

0.31 MB Mar 13' 2023

Agenda 06.02.2022

0.27 MB Mar 13' 2023

Agenda 06.08.2021

0.12 MB Mar 13' 2023

Agenda 06.19.2023

0.14 MB May 17' 2023

Agenda 06.30.2020

0.14 MB Mar 13' 2023

Agenda 09.27.2018

0.14 MB Mar 13' 2023

Agenda 10.28.2019

0.14 MB Mar 13' 2023

Agenda 12.02.2021

0.14 MB Mar 13' 2023

Agenda 12.13.2022

0.14 MB Mar 13' 2023

Agenda 12.15.2020

0.14 MB Mar 13' 2023

Minutes 06.02.2022

0.27 MB Mar 13' 2023

Minutes 12.02.2021

0.21 MB Mar 13' 2023

ZOOM Webinar Registration 06.19.2023

0.14 MB May 17' 2023

Adenosine Triphosphate-Citrate Lyase PA Form

1.75 MB Mar 10' 2023

Allergen Extract PA Form

1.77 MB Mar 10' 2023

Anti-Fungal Medication for Onychomycosis PA Form

1.71 MB Mar 10' 2023

Asthma-Allergy Immunomodulator PA Form

0.98 MB Mar 13' 2023

Bowel Disorders.GI Motility, Chronic PA Form

1.75 MB Mar 13' 2023

BPH PA Form

0.95 MB Mar 10' 2023

Brand Name Multisource Drug PA Form

1.72 MB Mar 10' 2023

Buprenorphine-Naloxone and Buprenorphine (Oral) PA Form

1.94 MB Mar 13' 2023

Carisoprodol and Combination PA Form

1.7 MB Mar 10' 2023

CGRP Inhibitor PA Form

1.04 MB Mar 10' 2023

CNS Stimulants (ADHD.ADD) PA Form

1.52 MB Mar 13' 2023

Codeine for Pediatric Use PA Form

1.73 MB Mar 10' 2023

Convenience Kits PA Form

1.76 MB Mar 10' 2023

Duchenne Muscular Dystrophy Agents PA Form

0.98 MB Mar 10' 2023

Duloxetine PA Form

1.77 MB Mar 10' 2023

Dupixent PA Form

2.14 MB Mar 10' 2023

Fibromyalgia PA Form

1.7 MB Mar 10' 2023

Hepatitis C PA Form

0.98 MB Mar 10' 2023

Hetlioz PA Form

1.72 MB Mar 10' 2023

Horizant PA Form

1.74 MB Mar 10' 2023

Human Growth Hormones PA Form

1.75 MB Mar 10' 2023

Hyaluronic Acid Derivatives Injection PA Form

0.99 MB Mar 10' 2023

Inhaled Insulin PA Form

1.72 MB Mar 10' 2023

Juxtapid PA Form

0.98 MB Mar 10' 2023

Long-acting Opioid Analgesic PA Form

1.76 MB Mar 10' 2023

Methadone PA Form

1.75 MB Mar 10' 2023

Monoclonal Antibody for Alzheimer's PA Form

1.01 MB Mar 10' 2023

Morphine Milligram Equivalent (MME) PA Form

1.74 MB Mar 10' 2023

Movement Disorders PA Form

1.73 MB Mar 10' 2023

New Drug Product PA Form

1.7 MB Mar 10' 2023

Non-Preferred Drug PA Form

1.75 MB Mar 10' 2023

Oral Isotretinoin PA Form

1.72 MB Mar 10' 2023

PCSK9 PA Form

1.72 MB Mar 10' 2023

Pregabalin PA Form

1.76 MB Mar 10' 2023

Psychoactive Meds for Children under 5 Criteria PA Form

1.71 MB Mar 10' 2023

Psychotropic Meds Duplicate Therapy Peds 6 and above PA Form

1.72 MB Mar 10' 2023

Pulmonary Arterial Hypertension PDE-5 PA Form

1.72 MB Mar 10' 2023

Rho Kinase Inhibitor PA Form

1.68 MB Mar 10' 2023

Second-Line Antifungal PA Form

0.97 MB Mar 10' 2023

Short-Acting Fentanyl PA Form

1.01 MB Mar 10' 2023

Skin Disorders PA Form

1.87 MB Mar 10' 2023

Skysona PA Form

1.78 MB Mar 10' 2023

Spinal Muscular Atrophy PA Form

1.81 MB Mar 10' 2023

Spravato PA Form

1.01 MB Mar 10' 2023

Stromectol PA Form

1.67 MB Mar 10' 2023

Symlin PA Form

1.73 MB Mar 10' 2023

Synagis PA Form

1.74 MB Mar 10' 2023

Systemic Immunomodulators PA Form

1.77 MB Mar 10' 2023

Verquvo PA Form

0.96 MB Mar 10' 2023

Vuity PA Form

0.95 MB Mar 10' 2023

Weight Management PA Form

2.25 MB Mar 10' 2023

Zynteglo PA Form

1.78 MB Mar 10' 2023

COVID-19 Testing and Treatment Group Coverage Ending

0.2 MB Mar 07' 2023

New Hampshire Medicaid Standing Orders OTC COVID Test Kits and Naloxone

0.27 MB Mar 03' 2023

Notification 01.01.2019 Diabetic Supply Program

0.14 MB Mar 13' 2023

Notification 01.12.2021 Pharmacist Provider Enrollment

0.19 MB Mar 13' 2023

Notification 01.21.2022 At-Home OTC COVID-19 Test Kits

0.24 MB Mar 13' 2023

Notification 02.01.2022 Clinical PA Updates-Web Portal Info-Email

0.07 MB Mar 13' 2023

Notification 02.01.2023 Clinical PA Updates-Web Portal Info-Email

0.13 MB Mar 13' 2023

Notification 03.12.2021 COVID-19 POS Billing Guidance update

0.15 MB Mar 13' 2023

Notification 03.12.2021 PDL-Clinical PA Updates-Web Portal Info-Email

0.16 MB Mar 13' 2023

Notification 03.15.2023 Pharmacist Provided Medical Services

0.19 MB Mar 20' 2023

Notification 03.16.2020 PDL-Clinical PA Updates-Web Portal Info-Email

0.08 MB Mar 13' 2023

Notification 03.28.2023 Standing Orders OTC COVID Test Kits

0.19 MB Mar 28' 2023

Notification 04.01.2021 COVID-19 POS Billing Guidance update

0.22 MB Mar 13' 2023

Notification 04.13.2023 Makena Withdrawal

0.07 MB Apr 14' 2023

Notification 04.14.2022 At-Home OTC COVID-19 Test Kits

0.27 MB Mar 13' 2023

Notification 04.22.2022 Diabetic Supply Program

0.15 MB Mar 13' 2023

Notification 05.01.2019 Diabetic Supply Program

0.14 MB Mar 13' 2023

Notification 06.01.2023 July PDL update

0.19 MB Jun 01' 2023

Notification 06.14.2019 PDL-Clinical PA Updates-Web Portal Info-Email

0.16 MB Mar 13' 2023

Notification 07.01.2019 Diabetic Supply Program

0.14 MB Mar 13' 2023

Notification 07.06.2021 Non-Enrolled Prescriber Edit

0.2 MB Mar 13' 2023

Notification 07.30.2019 340B Drug Discount Program_Effective 09.01.2019

0.4 MB Mar 13' 2023

Notification 08.01.2019 PDL and Changes to Pharmacy Carve Out

0.46 MB Mar 13' 2023

Notification 08.01.2022 PDL-Clinical PA Updates-Web Portal Info-Email

0.16 MB Mar 13' 2023

Notification 08.21.2018 Diabetic Supply Program

0.11 MB Mar 13' 2023

Notification 09.01.2020 PDL-Clinical PA Updates-Web Portal Info-Email

0.04 MB Mar 13' 2023

Notification 09.01.2021 COVID-19 POS Billing Guidance

0.22 MB Mar 13' 2023

Notification 09.07.2021 Clinical PA Updates-Web Portal Info-Email

0.15 MB Mar 13' 2023

Notification 10.01.2019 Diabetic Supply Program

0.14 MB Mar 13' 2023

Notification 10.01.2021 Diabetic Supply Program

0.14 MB Mar 13' 2023

Notification 10.01.2022 Diabetic Supply Program

0.14 MB Mar 13' 2023

Notification 11.04.2021 Pediatric Influenza Vaccines through POS

0.15 MB Mar 13' 2023

Notification 11.05.2020 340B Discount Program Effective_1.1.2021

0.43 MB Mar 13' 2023

Notification 11.28.2018 PDL-Clinical PA Updates-Web Portal Info-Email

0.15 MB Mar 13' 2023

Notification 12.01.2021 Clinical PA Updates-Web Portal Info-Email

0.17 MB Mar 13' 2023

Notification 12.05.2018 Diabetic Supply Program

0.13 MB Mar 13' 2023

Notification 12.10.2020 Prescriber Soft Edit

0.17 MB Mar 13' 2023

Notification 12.23.2020 COVID-19 POS Billing Guidance

0.21 MB Mar 13' 2023

Notification 12.31.2020 COVID-19 Billing Guidance update

0.21 MB Mar 13' 2023

CMS Rebate Participating Manufacturers

0.25 MB Mar 10' 2023

Diabetic Supply Covered Items List - Effective 10.1.2022

0.15 MB Apr 25' 2023

Dose Optimization Program

0.01 MB Mar 10' 2023

MAC Price Research Request Form

0.88 MB Mar 10' 2023

Maintenance Medications

0.25 MB Mar 10' 2023

Non-Legend Drug List

0.27 MB May 12' 2023

Payer Specification

0.9 MB Mar 10' 2023

Pharmacy Provider Manual - Revised 1.7.2022

0.98 MB Mar 13' 2023

Preferred Drug List - Effective 9.1.2022

1 MB Apr 25' 2023

Quantity Limit Program

0.23 MB Mar 10' 2023

Third Party Liability Other Payer ID Codes

0.15 MB Mar 10' 2023

Trading Partners FTP Instructions

0.44 MB Mar 10' 2023

Dose Optimization Program

0.01 MB Mar 10' 2023

Maintenance Medications

0.25 MB Mar 10' 2023

Non-Legend Drug List

0.27 MB May 12' 2023

Preferred Drug List - Effective 9.1.2022

1 MB Apr 25' 2023

Quantity Limit Program

0.23 MB Mar 10' 2023

Drug Coverage Lookup User Guide

1.13 MB Mar 10' 2023

Multi-Ingredient Compound Reference

0.03 MB Mar 10' 2023