Forms and Information
CMS Tamper Resistant Prescription Pad Implementation
CMS Tamper Resistant Prescription Pad Law_FAQ
CMS Tamper Resistant Prescription Pad Law_Pharmacist Fact Sheet
CMS Tamper Resistant Prescription Pad Law_Pharmacist Info
CMS TRPP State Medicaid Director Letter
Diabetic Supply Covered Items List - Effective 10.1.2023 (update 1.1.2024)
DUR Agenda 03.20.2017
DUR Agenda 05.12.2015
DUR Agenda 05.20.2014
DUR Agenda 05.31.2016
DUR Agenda 10.11.2016
DUR Agenda 10.24.2017
New Hampshire Medicaid Standing Orders OTC COVID Test Kits and Naloxone
Notification 01.01.2019 Diabetic Supply Program
Notification 01.09.2015 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 01.10.2017 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 01.12.2021 Pharmacist Provider Enrollment
Notification 01.21.2022 At-Home OTC COVID-19 Test Kits
Notification 02.01.2022 Clinical PA Updates-Web Portal Info-Email
Notification 03.12.2021 COVID-19 POS Billing Guidance update
Notification 03.12.2021 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 03.16.2020 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 04.01.2021 COVID-19 POS Billing Guidance update
Notification 04.02.2013 Change in TPL Field Length
Notification 04.14.2022 At-Home OTC COVID-19 Test Kits
Notification 04.22.2022 Diabetic Supply Program
Notification 05.01.2019 Diabetic Supply Program
Notification 05.17.2012 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 05.26.2017 Updated Fiscal Impact Regarding Outpatient Drug Rule
Notification 06.14.2019 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 06.16.2017 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 07.01.2019 Diabetic Supply Program
Notification 07.03.2014 Changes to Copay
Notification 07.06.2021 Non-Enrolled Prescriber Edit
Notification 07.20.2016 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 07.25.2012 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 07.30.2019 340B Drug Discount Program_Effective 09.01.2019
Notification 08.01.2014 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 08.01.2019 PDL and Changes to Pharmacy Carve Out
Notification 08.01.2022 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 08.04.2013 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 08.21.2018 Diabetic Supply Program
Notification 08.22.2012 Diabetic Supply Program Update
Notification 08.24.2015 PDL Transition
Notification 08.24.2015 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 09.01.2020 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 09.01.2021 COVID-19 POS Billing Guidance
Notification 09.07.2021 Clinical PA Updates-Web Portal Info-Email
Notification 10.01.2019 Diabetic Supply Program
Notification 10.01.2021 Diabetic Supply Program
Notification 10.01.2022 Diabetic Supply Program
Notification 10.08.2017 Emergency Drug Coverage Reminder
Notification 10.30.2014 NHHPP Reinstatement of Co-Pays
Notification 11.04.2021 Pediatric Influenza Vaccines through POS
Notification 11.05.2020 340B Discount Program Effective_1.1.2021
Notification 11.28.2018 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 12.01.2021 Clinical PA Updates-Web Portal Info-Email
Notification 12.05.2018 Diabetic Supply Program
Notification 12.06.2012 Benzodiazepines and Barbiturates in Dual Eligibles
Notification 12.07.2012 Diabetic Supply Program
Notification 12.10.2020 Prescriber Soft Edit
Notification 12.15.2017 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 12.23.2020 COVID-19 POS Billing Guidance
Notification 12.31.2020 COVID-19 Billing Guidance update
Preferred Drug List - Effective 3.1.2024
Preferred Drug List - Effective 7.1.2023 updated 1.24.2024
Adenosine Triphosphate-Citrate Lyase Criteria
Antifungal for Onychomycosis Criteria
Asthma-Allergy Immunomodulator Criteria
Bowel Disorders.GI Motility, Chronic Criteria
BPH Criteria
Brand Name Multisource Drug Criteria
Buprenorphine-Naloxone and Buprenorphine (Oral) Criteria
Carisoprodol and Combination Criteria
CGRP Inhibitor Criteria
CNS Stimulants (ADHD.ADD) Criteria
Codeine for Pediatric Use Criteria
Convenience Kits Criteria
Duchenne Muscular Dystrophy Agents Criteria
Dupixent Criteria
Elevidys Criteria
GLP-1 Receptor Agonist Criteria
Hematopoietic Agent Criteria
Hemgenix Criteria
Hepatitis C Criteria
Hetlioz Criteria
Horizant Criteria
Human Growth Hormones Criteria
Hyaluronic Acid Derivatives Injection Criteria
Juxtapid Criteria
Long-acting Opioid Analgesic Criteria
Methadone Criteria
Monoclonal Antibody for Alzheimer's Criteria
Morphine Milligram Equivalent (MME) Criteria
Movement Disorders Criteria
New Drug Product Criteria
Oral Isotretinoin Criteria
PCSK9 Criteria
Psychoactive Meds for Children under 5 Criteria
Psychotropic Meds Duplicate Therapy Peds 6 and above Criteria
Pulmonary Arterial Hypertension PDE-5 Criteria
Rho Kinase Inhibitor Criteria
Roctavian Criteria
Second-Line Antifungal Criteria
Short-Acting Fentanyl Criteria
Skin Disorders Criteria
Skysona Criteria
Spinal Muscular Atrophy Criteria
Spravato Criteria
Stromectol Criteria
Synagis Criteria
Systemic Immunomodulator Criteria
Topical Retinoids Criteria
Verquvo Criteria
Vuity Criteria
Weight Management Criteria
Zynteglo Criteria
Agenda 03.12.2019
Agenda 05.03.2018
Agenda 06.02.2022
Agenda 06.08.2021
Agenda 06.19.2023
Agenda 06.30.2020
Agenda 09.27.2018
Agenda 10.28.2019
Agenda 12.02.2021
Agenda 12.13.2022
Agenda 12.15.2020
Agenda 5.7.2024
Minutes 06.02.2022
Minutes 12.02.2021
Minutes 12.13.2022
Minutes 6.19.2023
Adenosine Triphosphate-Citrate Lyase PA Form
Anti-Fungal Medication for Onychomycosis PA Form
Asthma-Allergy Immunomodulator PA Form
Bowel Disorders.GI Motility, Chronic PA Form
BPH PA Form
Brand Name Multisource Drug PA Form
Buprenorphine-Naloxone and Buprenorphine (Oral) PA Form
Carisoprodol and Combination PA Form
CGRP Inhibitor PA Form
CNS Stimulants (ADHD.ADD) PA Form
Codeine for Pediatric Use PA Form
Convenience Kits PA Form
Duchenne Muscular Dystrophy PA Form.pdf
Dupixent PA Form
Elevidys PA Form
GLP-1 Receptor Agonist PA Form
Hemgenix PA Form.pdf
Hepatitis C PA Form
Hetlioz PA Form
Horizant PA Form
Human Growth Hormones PA Form
Hyaluronic Acid Derivatives Injection PA Form.pdf
Juxtapid PA Form
Long-acting Opioid Analgesic PA Form
Methadone PA Form
Monoclonal Antibody for Alzheimers PA Form.pdf
Morphine Milligram Equivalent (MME) PA Form
Movement Disorders PA Form
New Drug Product PA Form
Non-Preferred Drug PA Form
Oral Isotretinoin PA Form
PCSK9 PA Form
Psychoactive Meds for Children under 5 Criteria PA Form
Psychotropic Meds Duplicate Therapy Peds 6 and above PA Form
Pulmonary Arterial Hypertension PDE-5 PA Form
Rho Kinase Inhibitor PA Form
Roctavian PA Form
Second-Line Antifungal PA Form
Short-Acting Fentanyl PA Form
Skin Disorders PA Form
Skysona PA Form.pdf
Spinal Muscular Atrophy PA Form.pdf
Spravato PA Form
Stromectol PA Form
Synagis PA Form
Systemic Immunomodulators Medication PA Form.pdf
Topical Retinoids PA Form
Verquvo PA Form
Vuity PA Form
Weight Management PA Form
Zynteglo PA Form.pdf
NHRx_MAC_listing_weekly_changes.pdf
NHRx_MAC_listing.pdf
NHRx_MAC_Price_Research_Request_Form.pdf
COVID-19 Testing and Treatment Group Coverage Ending
Notification 02.01.2023 Clinical PA Updates-Web Portal Info-Email
Notification 03.15.2023 Pharmacist Provided Medical Services
Notification 03.28.2023 Standing Orders OTC COVID Test Kits
Notification 04.13.2023 Makena Withdrawal
Notification 06.01.2023 July PDL update
Notification 06.20.2023 July PDL update
Notification 06.30.2023 August Clinical PA Updates
Notification 1.23.2024 Standing Order Opioid Antagonist
Notification 1.26.2024 PDL-Clinical PA Updates-Web Portal Info-Email
Notification 12.1.2023 Carve out Program effective 1.1.2024
Notification 340B Program effective 1.1.2024
Pharmacy Language Access Services Reminder
CMS Rebate Participating Manufacturers
Diabetic Supply Covered Items List - Effective 10.1.2023 (update 3.15.2024)
Dose Optimization Program
MAC Price Research Request Form
Maintenance Medications
Non-Legend Drug List
Payer Specification
Pharmacy Provider Manual - Revised 6.16.2023
Preferred Drug List - Effective 3.1.2024
Quantity Limit Program
Third Party Liability Other Payer ID Codes
Trading Partners FTP Instructions
Dose Optimization Program
Maintenance Medications
Non-Legend Drug List
Preferred Drug List - Effective 3.1.2024
Quantity Limit Program
Drug Coverage Lookup User Guide
Multi-Ingredient Compound Reference