Individual pharmacists must enroll with Minnesota Health Care Programs starting January 1, 2027.

What’s Changing?

Effective January 1, 2027, Minnesota Health Care Programs (MHCP) will require the NPI of the prescribing pharmacist to be included on pharmacy claims when ordered or prescribed by individual pharmacists using Minnesota Board of Pharmacy approved protocols.

Claim Impact

All claims dispensed with a pharmacy or a pharmacist NPI that is not enrolled with MHCP will reject with the following message: “prescriber not enrolled with Minnesota Medicaid.”

Action Required

Individual pharmacists are required to enroll with MHCP to prevent potential billing disruptions. Refer to Pharmacy and Pharmacist Enrollment Criteria and Forms in the MHCP Provider Manual for enrollment information. Need Assistance? If you have questions about provider enrollment, contact the MHCP Provider Resource Center at 651- 431-2700 or 800-366-5411.

For claims processing questions, contact Prime Therapeutics at 844-575-7887.

DHS has approved an update to the list of cost-effective generic medications that may be dispensed in a quantity sufficient for a 90 day supply to Fee-for-Service Medicaid members, effective April 24, 2026. Dispense of a 90 day supply is not mandatory. All medications not found on this list are limited to a maximum of a 34 day supply per Minnesota Statutes 256B.0625, subdivision 13(b). https://minnesota.primetherapeutics.com/forms-and-documents

New Procedures for Fee-for-Service Prescription Claims Starting February 9, 2026.

Overview

• Beginning February 9, 2026, Minnesota pharmacies processing Fee-for-Service prescription claims will see changes to how professional dispensing fees are handled. Prevention of duplicate professional dispensing fees will be automated at point of sale for maintenance medications as assigned by First Databank (FDB).  Minnesota Rules part 9505.340 indicates that dispensing fees are limited to one fee per 30-day supply of a maintenance medication unless it is documented on the prescription that a significant chance for overdosage exists by dispensing such a quantity.

What’s Changing?

• Claims for maintenance drugs with the same active ingredient and strength will pay only one dispensing fee per member every 21 days, unless the submission includes clarification code 47 for a shortened days’ supply fill.

  • When using submission clarification code 47, the reason must be documented on the prescription.

• If a claim for a maintenance drug occurs within 21 days of the previous fill and doesn’t include code 47, only the ingredient cost will be reimbursed—no dispensing fee will be paid.

Exclusions

• Drugs that do not have an FDB maintenance indicator are excluded.

• Maintenance medications refilled 22 days or more after the last fill will receive a new dispensing fee.

Need Assistance

For more information, contact the Prime Therapeutics Call Center at 844-575-7887

Effective October 1, 2025, Salix Pharmaceuticals, Inc. will no longer participate in the federal Medicaid Drug Rebate Program. As a result, Medical Assistance (MA) will no longer cover Salix products under the Fee-for-Service Program. This includes commonly prescribed medications such as:

• Xifaxan®
• Relistor®
• Trulance®

Under federal and state law, MA can only cover drugs that are eligible for federal funding through the rebate program. While manufacturer participation is voluntary, opting out means their products cannot be reimbursed by MA. Please note that other manufacturers have also chosen to leave the program effective October 1, 2025.

What You Can Do:

Prescribers: Consider alternative medications that remain covered under MA.

Patients: Contact your healthcare provider to discuss treatment options.

Pharmacies: Adjust inventory and billing practices to avoid claim denials.

For a complete list of affected manufacturers, visit the Drug Manufacturer Contacts webpage on the U.S. Centers for Medicare & Medicaid website.