ForwardHealth Provider Type: 24, Pharmacy

Welcome » May 1, 2025 9:28 PM

	Alerts
	Children’s Long-Term Support (CLTS) Program Providers and County Waiver Agencies: The CLTS Operations Team is available for your questions about submitting prior authorizations (PAs) or claims for CLTS services. Reach the CLTS Operations Team at 844-942-5870 or CLTSOperations@gainwelltechnologies.com. Attention CLTS Providers: The CLTS Prior Authorization Conversion is still processing. If you have any difficulties submitting claims, please contact the CLTS Operations Team at 844-942-5870 or CLTSOperations@gainwelltechnologies.com.

Pharmacy

	Alerts
	HIV Drug Assistance Program Claim Denials: The ForwardHealth system was inappropriately denying claims for members in the Wisconsin HIV Drug Assistance Program (HDAP) submitted on February 16 and 17, 2025. The system is now fixed. You can now resubmit any inappropriately denied HDAP claims. Please note, due to the program name change, the group ID “ADAP” is no longer valid; please use the group ID “HDAP."

Preferred Drug List Quick Reference (Effective 5/1/2025)
Diabetic Supply List Quick Reference (Effective 5/15/2025)
Diabetic Supply List Quick Reference (Effective 1/1/2025)
Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Effective 4/1/2025)
- Covered by HealthCheck "Other Services" (Effective 4/1/2025)
Wisconsin HIV Drug Assistance Program (HDAP) Formulary
- PDF

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 5/1/2025)
Covered Active Pharmaceutical Ingredients (APIs) and Excipients (Effective 6/1/2020)
Diagnosis Restricted Drugs (Effective 5/1/2025)
Early Refill Drug Utilization Review Drugs (Effective 12/1/2022)
Expedited Emergency Supply Request Drugs (Effective 1/1/2025)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 5/1/2025)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 4/1/2025)
Influenza Vaccine Procedure Codes Reimbursable to Outpatient Pharmacies for Wisconsin Medicaid and
BadgerCare Plus fee-for-service and Managed Care Members -- November 14, 2014.
Medications monitored by the Pharmacy Services Lock-In Program (Effective 1/1/2012)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 5/1/2025)
Prospective Drug Utilization Review Alerts (Effective 12/1/2022)
Quantity Limit Drugs and Diabetic Supplies (Effective 5/1/2025)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 4/1/2025)
Three-Month Supply Drugs (Effective 12/1/2024)
Explanation of Benefits Report (Effective 4/10/2025)
- EOBs on Denied Claims for March 2025
- EOBs on Paid Claims for March 2025