The West Virginia Medicaid Pharmacy Program is an optional fee-for-service benefit offered to all eligible members, including those who are enrolled in Medicaid Managed Care plans. In Calendar Year 2014, WV Medicaid reimbursed over six and a half million prescription claims for a total of over $377.6M. Most prescription and some over-the-counter medications are covered as defined by federal law and regulations. The Pharmacy Program uses a Preferred Drug List with criteria established for non-preferred products. Some medications may be limited in quantity, by gender, or prior authorization requirements.
Coverage policies and important information about the Pharmacy Program are found on this website and in the West Virginia Medicaid Provider Manual, Chapter 518, Pharmacy Services. Billing Instructions and other important information can be found on the Medicaid fiscal agent, Molina Medicaid Solutions' website https://www.wvmmis.com/Default.aspx