Archived Pharmacy Data Tables

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Archived Pharmacy Data Tables

Pharmacy

Archived Data Tables

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March 2024 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 3/1/2024)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 1/1/2024)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 3/1/2024)
Diagnosis Restricted Drugs (Effective 3/1/2024)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 3/1/2024)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 3/1/2024)
Explanation of Benefits Report (Effective 3/10/2024)
- EOBs on Denied Claims for February 2024
- EOBs on Paid Claims for February 2024

February 2024 Data Tables

Covered (BadgerCare Plus and Medicaid) (Effective 2/1/2024)
Quantity Limit Drugs and Diabetic Supplies (Effective 2/1/2024)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 2/1/2024)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 2/19/2024)
Diagnosis Restricted Drugs (Effective 12/1/2023)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 2/1/2024)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 2/1/2024)
Explanation of Benefits Report (Effective 2/10/2024)
- EOBs on Denied Claims for January 2024
- EOBs on Paid Claims for January 2024

January 2024 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 1/1/2024)
Covered (BadgerCare Plus and Medicaid) (Effective 12/1/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 1/1/2024)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 1/15/2024)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 1/1/2024)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 1/1/2024)
Explanation of Benefits Report (Effective 1/10/2024)
- EOBs on Denied Claims for December 2023
- EOBs on Paid Claims for December 2023

December 2023 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 11/1/2023)
Expedited Emergency Supply Request Drugs (Effective 7/1/2023)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 8/1/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 11/1/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 12/20/2023)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 12/1/2023)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 12/1/2023)
Explanation of Benefits Report (Effective 12/10/2023)
- EOBs on Denied Claims for November 2023
- EOBs on Paid Claims for November 2023

November 2023 Data Tables

Covered (BadgerCare Plus and Medicaid) (Effective 5/1/2023)
Diagnosis Restricted Drugs (Effective 11/1/2023)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 11/1/2023)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 11/1/2023)
Explanation of Benefits Report (Effective 11/10/2023)
- EOBs on Denied Claims for October 2023
- EOBs on Paid Claims for October 2023

October 2023 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 10/1/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 9/19/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 10/23/2023)
Diagnosis Restricted Drugs (Effective 10/1/2023)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 10/1/2023)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 10/1/2023)
Three-Month Supply Drugs (Effective 12/8/2022)
Explanation of Benefits Report (Effective 10/10/2023)
- EOBs on Denied Claims for September 2023
- EOBs on Paid Claims for September 2023

September 2023 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 9/1/2023)
Covered by HealthCheck "Other Services" (Effective 5/1/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 9/1/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 9/8/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 9/11/2023)
Diagnosis Restricted Drugs (Effective 9/1/2023)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 9/1/2023)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 9/1/2023)
Explanation of Benefits Report (Effective 9/10/2023)
- EOBs on Denied Claims for August 2023
- EOBs on Paid Claims for August 2023

August 2023 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 8/1/2023)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 2/1/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 8/1/2023)
Diagnosis Restricted Drugs (Effective 8/1/2023)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 8/1/2023)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 8/1/2023)
Explanation of Benefits Report (Effective 8/10/2023)
- EOBs on Denied Claims for July 2023
- EOBs on Paid Claims for July 2023

July 2023 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 7/1/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 7/1/2023)
Diagnosis Restricted Drugs (Effective 7/1/2023)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 7/1/2023)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 7/1/2023)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 7/5/2023)
Explanation of Benefits Report (Effective 7/10/2023)
- EOBs on Denied Claims for June 2023
- EOBs on Paid Claims for June 2023

June 2023 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 6/1/2023)
Expedited Emergency Supply Request Drugs (Effective 1/1/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 6/1/2023)
Diagnosis Restricted Drugs (Effective 6/1/2023)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 6/1/2023)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 6/1/2023)
Explanation of Benefits Report (Effective 6/10/2023)
- EOBs on Denied Claims for May 2023
- EOBs on Paid Claims for May 2023

May 2023 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 5/1/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 5/1/2023)
Diagnosis Restricted Drugs (Effective 1/1/2023)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 5/1/2023)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 5/1/2023)
Explanation of Benefits Report (Effective 5/10/2023)
- EOBs on Denied Claims for April 2023
- EOBs on Paid Claims for April 2023

April 2023 Data Tables

Covered (BadgerCare Plus and Medicaid) (Effective 2/1/2023)
Quantity Limit Drugs and Diabetic Supplies (Effective 4/1/2023)
Covered by HealthCheck "Other Services" (Effective 12/1/2022)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 2/21/2023)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 4/1/2023)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 4/1/2023)
Explanation of Benefits Report (Effective 4/10/2023)
- EOBs on Denied Claims for March 2023
- EOBs on Paid Claims for March 2023

March 2023 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 3/1/2023)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 3/1/2023)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 3/1/2023)
Explanation of Benefits Report (Effective 3/10/2023)
- EOBs on Denied Claims for February 2023
- EOBs on Paid Claims for February 2023

February 2023 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 2/1/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 2/1/2023)
Diagnosis Restricted Drugs (Effective 1/1/2023)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 2/1/2023)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 2/1/2023)
Explanation of Benefits Report (Effective 2/10/2023)
- EOBs on Denied Claims for January 2023
- EOBs on Paid Claims for January 2023

January 2023 Data Tables

Covered (BadgerCare Plus and Medicaid) (Effective 8/1/2022)
Quantity Limit Drugs and Diabetic Supplies (Effective 1/1/2023)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 1/1/2023)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 1/1/2023)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 1/1/2023)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 1/1/2023)
Explanation of Benefits Report (Effective 1/10/2023)
- EOBs on Denied Claims for December 2022
- EOBs on Paid Claims for December 2022

December 2022 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 12/1/2022)
Expedited Emergency Supply Request Drugs (Effective 12/1/2022)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 11/1/2022)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 10/10/2022)
Diagnosis Restricted Drugs (Effective 10/1/2022)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 12/1/2022)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 12/1/2022)
Opioids Included in the Prescription Fill Limit (Effective 9/1/2013)
Three-Month Supply Drugs (Effective 12/1/2022)
Explanation of Benefits Report (Effective 12/10/2022)
- EOBs on Denied Claims for November 2022
- EOBs on Paid Claims for November 2022

November 2022 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 2/1/2022)
Expedited Emergency Supply Request Drugs (Effective 7/1/2022)
Covered by HealthCheck "Other Services" (Effective 9/1/2022)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 11/1/2022)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 11/1/2022)
Prospective Drug Utilization Review Alerts (Effective 10/1/2021)
Early Refill Drug Utilization Review Drugs (Effective 8/1/2018)
Three-Month Supply Drugs (Effective 8/1/2018)
Explanation of Benefits Report (Effective 11/10/2022)
- EOBs on Denied Claims for October 2022
- EOBs on Paid Claims for October 2022

October 2022 Data Tables

Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 7/1/2022)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 10/1/2022)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 10/1/2022)
Explanation of Benefits Report (Effective 10/10/2022)
- EOBs on Denied Claims for September 2022
- EOBs on Paid Claims for September 2022

September 2022 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 9/19/2022)
Explanation of Benefits Report (Effective 9/10/2022)
- EOBs on Denied Claims for August 2022
- EOBs on Paid Claims for August 2022

September 2022 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 7/11/2022)
Diagnosis Restricted Drugs (Effective 7/1/2022)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 9/1/2022)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 9/1/2022)

August 2022 Data Tables

Covered by HealthCheck "Other Services" (Effective 8/1/2021)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 8/1/2022)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 8/1/2022)
Explanation of Benefits Report (Effective 8/10/2022)
- EOBs on Denied Claims for July 2022
- EOBs on Paid Claims for July 2022

July 2022 Data Tables

Covered (BadgerCare Plus and Medicaid) (Effective 1/1/2022)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 7/1/2022)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 7/1/2022)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 7/1/2022)
Explanation of Benefits Report (Effective 7/10/2022)
- EOBs on Denied Claims for June 2022
- EOBs on Paid Claims for June 2022

June 2022 Data Tables

Expedited Emergency Supply Request Drugs (Effective 1/1/2022)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 5/1/2022)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 6/1/2022)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 6/3/2022)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 6/11/2022)
Diagnosis Restricted Drugs (Effective 4/1/2022)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 6/1/2022)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 6/1/2022)
Explanation of Benefits Report (Effective 6/10/2022)
- EOBs on Denied Claims for May 2022
- EOBs on Paid Claims for May 2022

May 2022 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 5/1/2022)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 5/20/2022)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 5/1/2022)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 5/1/2022)
Explanation of Benefits Report (Effective 5/10/2022)
- EOBs on Denied Claims for April 2022
- EOBs on Paid Claims for April 2022

April 2022 Data Tables

Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 4/1/2022)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 4/1/2022)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 4/1/2022)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 4/1/2022)
Explanation of Benefits Report (Effective 4/10/2022)
- EOBs on Denied Claims for March 2022
- EOBs on Paid Claims for March 2022

March 2022 Data Tables

Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 3/6/2022)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 2/18/2022)
Diagnosis Restricted Drugs (Effective 1/1/2022)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 3/1/2022)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 3/1/2022)
Explanation of Benefits Report (Effective 3/10/2022)
- EOBs on Denied Claims for February 2022
- EOBs on Paid Claims for February 2022

February 2022 Data Tables

Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 2/1/2022)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 2/1/2022)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 2/1/2022)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 2/1/2022)
Explanation of Benefits Report (Effective 2/10/2022)
- EOBs on Denied Claims for January 2022
- EOBs on Paid Claims for January 2022

January 2022 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 9/1/2021)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 1/1/2022)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 1/1/2022)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 1/1/2022)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 1/1/2022)
Explanation of Benefits Report (Effective 1/10/2022)
- EOBs on Denied Claims for December 2021
- EOBs on Paid Claims for December 2021

December 2021 Data Tables

Expedited Emergency Supply Request Drugs (Effective 7/1/2021)
Covered (BadgerCare Plus and Medicaid) (Effective 1/1/2021)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 10/1/2021)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 9/1/2021)
Diagnosis Restricted Drugs (Effective 12/1/2021)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 12/1/2021)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 12/1/2021)
Explanation of Benefits Report (Effective 12/10/2021)
- EOBs on Denied Claims for November 2021
- EOBs on Paid Claims for November 2021

November 2021 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 9/1/2021)
Diagnosis Restricted Drugs (Effective 5/1/2021)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 11/1/2021)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 11/1/2021)
Explanation of Benefits Report (Effective 11/10/2021)
- EOBs on Denied Claims for October 2021
- EOBs on Paid Claims for October 2021

October 2021 Data Tables

State and Specialty Pharmacy Drug Reimbursement Rates (Effective 10/1/2021)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 10/1/2021)
Explanation of Benefits Report (Effective 10/10/2021)
- EOBs on Denied Claims for September 2021
- EOBs on Paid Claims for September 2021

September 2021 Data Tables

Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 9/1/2021)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 9/1/2021)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 9/1/2021)
Prospective Drug Utilization Review Alerts (Effective 3/1/2021)
Explanation of Benefits Report (Effective 9/10/2021)
- EOBs on Denied Claims for August 2021
- EOBs on Paid Claims for August 2021

August 2021 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 3/1/2020)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 4/1/2021)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 7/1/2021)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 8/1/2021)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 8/1/2021)
Explanation of Benefits Report (Effective 8/10/2021)
- EOBs on Denied Claims for July 2021
- EOBs on Paid Claims for July 2021

July 2021 Data Tables

Covered by HealthCheck "Other Services" (Effective 7/1/2021)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 7/1/2021)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 7/1/2021)
Explanation of Benefits Report (Effective 7/10/2021)
- EOBs on Denied Claims for June 2021
- EOBs on Paid Claims for June 2021

June 2021 Data Tables

Expedited Emergency Supply Request Drugs (Effective 4/1/2021)
Covered by HealthCheck "Other Services" (Effective 1/1/2021)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 6/1/2021)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 6/1/2021)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 6/1/2021)
Explanation of Benefits Report (Effective 6/10/2021)
- EOBs on Denied Claims for May 2021
- EOBs on Paid Claims for May 2021

May 2021 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 5/1/2021)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 5/1/2021)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 5/1/2021)
Explanation of Benefits Report (Effective 5/10/2021)
- EOBs on Denied Claims for April 2021
- EOBs on Paid Claims for April 2021

April 2021 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 2/1/2021)
Diagnosis Restricted Drugs (Effective 1/1/2021)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 4/1/2021)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 4/1/2021)
Explanation of Benefits Report (Effective 4/10/2021)
- EOBs on Denied Claims for March 2021
- EOBs on Paid Claims for March 2021

March 2021 Data Tables

Expedited Emergency Supply Request Drugs (Effective 1/1/2021)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 3/15/2021)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 3/1/2021)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 3/1/2021)
Explanation of Benefits Report (Effective 3/10/2021)
- EOBs on Denied Claims for February 2021
- EOBs on Paid Claims for February 2021

February 2021 Data Tables

Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 2/1/2021)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 2/1/2021)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 2/1/2021)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 2/1/2021)
Explanation of Benefits Report (Effective 2/10/2021)
- EOBs on Denied Claims for January 2021
- EOBs on Paid Claims for January 2021

January 2021 Data Tables

Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 10/1/2020)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 1/1/2021)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 1/1/2021)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 1/1/2021)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 1/1/2021)
Explanation of Benefits Report (Effective 1/10/2021)
- EOBs on Denied Claims for December 2020
- EOBs on Paid Claims for December 2020

December 2020 Data Tables

Expedited Emergency Supply Request Drugs (Effective 7/1/2020)
Covered (BadgerCare Plus and Medicaid) (Effective 1/1/2018)
Covered by HealthCheck "Other Services" (Effective 9/1/2020)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 12/1/2020)
Diagnosis Restricted Drugs (Effective 10/1/2020)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 12/1/2020)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 12/1/2020)
Explanation of Benefits Report (Effective 12/10/2020)
- EOBs on Denied Claims for November 2020
- EOBs on Paid Claims for November 2020

November 2020 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 11/1/2020)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 11/1/2020)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 11/1/2020)
Explanation of Benefits Report (Effective 11/10/2020)
- EOBs on Denied Claims for October 2020
- EOBs on Paid Claims for October 2020

October 2020 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 10/20/2020)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 10/8/2020)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 10/1/2020)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 10/1/2020)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 10/1/2020)
Explanation of Benefits Report (Effective 10/10/2020)
- EOBs on Denied Claims for September 2020
- EOBs on Paid Claims for September 2020

September 2020 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 9/1/2020)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 9/1/2020)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 9/1/2020)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 9/1/2020)
Diagnosis Restricted Drugs (Effective 7/1/2020)
Explanation of Benefits Report (Effective 9/10/2020)
- EOBs on Denied Claims for August 2020
- EOBs on Paid Claims for August 2020

August 2020 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 8/1/2020)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 8/1/2020)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 8/1/2020)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 2/12/2020)
Covered by HealthCheck "Other Services" (Effective 11/1/2019)
Explanation of Benefits Report (Effective 8/10/2020)
- EOBs on Denied Claims for July 2020
- EOBs on Paid Claims for July 2020

July 2020 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 7/1/2020)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 7/1/2020)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 7/1/2020)
Explanation of Benefits Report (Effective 7/10/2020)
- EOBs on Denied Claims for June 2020
- EOBs on Paid Claims for June 2020

June 2020 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 6/1/2020)
Diagnosis Restricted Drugs (Effective 2/1/2020)
Expedited Emergency Supply Request Drugs (Effective 4/1/2020)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 6/1/2020)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 6/1/2020)
Explanation of Benefits Report (Effective 6/10/2020)
- EOBs on Denied Claims for May 2020
- EOBs on Paid Claims for May 2020

May 2020 Data Tables

Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 5/1/2020)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 5/1/2020)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 5/1/2020)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 3/1/2014)
Explanation of Benefits Report (Effective 5/10/2020)
- EOBs on Denied Claims for April 2020
- EOBs on Paid Claims for April 2020

April 2020 Data Tables

Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 4/1/2020)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 3/1/2020)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 4/1/2020)
Explanation of Benefits Report (Effective 4/10/2020)
- EOBs on Denied Claims for March 2020
- EOBs on Paid Claims for March 2020

March 2020 Data Tables

Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 3/1/2020)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 3/1/2020)
Expedited Emergency Supply Request Drugs (Effective 1/1/2020)
Explanation of Benefits Report (Effective 3/10/2020)
- EOBs on Denied Claims for February 2020
- EOBs on Paid Claims for February 2020

February 2020 Data Tables

Quantity Limit Drugs and Diabetic Supplies (Effective 2/1/2020)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 2/1/2020)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 2/1/2020)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 2/1/2020)
Revised due to incorrect effective date:Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 2/12/2020)
Explanation of Benefits Report (Effective 2/10/2020)
- EOBs on Denied Claims for January 2020
- EOBs on Paid Claims for January 2020

January 2020 Data Tables

Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 12/1/2019)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 1/1/2020)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 12/1/2019)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 1/1/2020)
Quantity Limit Drugs and Diabetic Supplies (Effective 1/1/2020)
Diagnosis Restricted Drugs (Published 1/17/2020)
Diagnosis Restricted Drugs (Published 1/8/2020)
Diagnosis Restricted Drugs (Published 12/20/2019)
Explanation of Benefits Report (Effective 1/10/2020)
- EOBs on Denied Claims for December 2019
- EOBs on Paid Claims for December 2019

December 2019 Data Tables

Diagnosis Restricted Drugs (Effective 8/1/2019)
Expedited Emergency Supply Request Drugs (Effective 07/01/2019)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 12/1/2019)
Quantity Limit Drugs and Diabetic Supplies (Effective 11/1/2019)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 12/1/2019)
Explanation of Benefits Report (Effective 12/10/2019)
- EOBs on Denied Claims for November 2019
- EOBs on Paid Claims for November 2019

November 2019 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 11/1/2019)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 11/1/2019)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 11/1/2019)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 6/1/2019)
Explanation of Benefits Report (Effective 11/10/2019)
- EOBs on Denied Claims for October 2019
- EOBs on Paid Claims for October 2019

October 2019 Data Tables

Over-the-Counter Drugs
- Covered by HealthCheck "Other Services" (Effective 8/1/2019)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 10/1/2019)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 10/1/2019)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 10/1/2019)
Quantity Limit Drugs and Diabetic Supplies (Effective 9/1/2019)
Explanation of Benefits Report (Effective 10/10/2019)
- EOBs on Denied Claims for September 2019
- EOBs on Paid Claims for September 2019

September 2019 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 7/1/2019)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 9/1/2019)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 9/1/2019)
Explanation of Benefits Report (Effective 9/10/2019)
- EOBs on Denied Claims for August 2019
- EOBs on Paid Claims for August 2019

August 2019 Data Tables

Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 8/1/2019)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 8/1/2019)
Quantity Limit Drugs and Diabetic Supplies (Effective 8/1/2019)
Explanation of Benefits Report (Effective 8/10/2019)
- EOBs on Denied Claims for July 2019
- EOBs on Paid Claims for July 2019

July 2019 Data Tables

Over-the-Counter Drugs
- Covered by HealthCheck "Other Services" (Effective 5/1/2018)
Diagnosis Restricted Drugs (Effective 7/1/2019)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 7/1/2019)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 7/1/2019)
Quantity Limit Drugs and Diabetic Supplies (Effective 7/1/2019)
Explanation of Benefits Report (Effective 7/10/2019)
- EOBs on Denied Claims for June 2019
- EOBs on Paid Claims for June 2019

June 2019 Data Tables

Diagnosis Restricted Drugs (Effective 6/1/2019)
Early Refill Drug Utilization Review Drugs (Effective 5/1/2019)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 5/1/2019)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 6/1/2019)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 6/1/2019)
Quantity Limit Drugs and Diabetic Supplies (Effective 6/1/2019)
Explanation of Benefits Report (Effective 6/10/2019)
- EOBs on Denied Claims for May 2019
- EOBs on Paid Claims for May 2019

May 2019 Data Tables

Diagnosis Restricted Drugs (Effective 1/1/2019)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 5/1/2019)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 5/1/2019)
Quantity Limit Drugs and Diabetic Supplies (Effective 5/1/2019)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 3/1/2019)
Explanation of Benefits Report (Effective 5/10/2019)
- EOBs on Denied Claims for April 2019
- EOBs on Paid Claims for April 2019

April 2019 Data Tables

Expedited Emergency Supply Request Drugs (Published 12/14/2018)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 4/1/2019)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 4/1/2019)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 4/1/2019)
Quantity Limit Drugs and Diabetic Supplies (Effective 4/1/2019)
Explanation of Benefits Report (Effective 4/10/2019)
- EOBs on Denied Claims for March 2019
- EOBs on Paid Claims for March 2019

March 2019 Data Tables

Expedited Emergency Supply Request Drugs (Published 12/14/2018)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 3/1/2019)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 3/1/2019)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 3/1/2019)
Quantity Limit Drugs and Diabetic Supplies (Effective 3/1/2019)
Explanation of Benefits Report (Effective 3/10/2019)
- EOBs on Denied Claims for February 2019
- EOBs on Paid Claims for February 2019

February 2019 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 2/1/2019)
Revised 2/11/2019: Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 2/1/2019)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 2/1/2019)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 2/1/2019)
Quantity Limit Drugs and Diabetic Supplies (Effective 1/1/2019)
Select High Cost, Orphan, and Accelerated Approval Drugs (Effective 12/3/2018)
Explanation of Benefits Report (Effective 2/10/2019)
- EOBs on Denied Claims for January 2019
- EOBs on Paid Claims for January 2019

January 2019 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 1/1/2019)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 1/1/2019)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 1/1/2019)
Explanation of Benefits Report (Effective 1/10/2019)
- EOBs on Denied Claims for December 2018
- EOBs on Paid Claims for December 2018

December 2018 Data Tables

Diagnosis Restricted Drugs (Effective 12/1/2018)
Expedited Emergency Supply Request Drugs (Published 06/15/2018)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 12/1/2018)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 12/1/2018)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 12/1/2018)
Quantity Limit Drugs and Diabetic Supplies (Effective 12/1/2018)
Explanation of Benefits Report (Effective 12/10/2018)
- EOBs on Denied Claims for November 2018
- EOBs on Paid Claims for November 2018

November 2018 Data Tables

Diagnosis Restricted Drugs (Effective 9/1/2018)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 11/1/2018)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 11/1/2018)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 11/1/2018)
Quantity Limit Drugs and Diabetic Supplies (Effective 11/1/2018)
Explanation of Benefits Report (Effective 11/10/2018)
- EOBs on Denied Claims for October 2018
- EOBs on Paid Claims for October 2018

October 2018 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 9/29/2018)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 10/1/2018)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 10/1/2018)
Quantity Limit Drugs and Diabetic Supplies (Effective 9/1/2018)
Explanation of Benefits Report (Effective 10/10/2018)
- EOBs on Denied Claims for September 2018
- EOBs on Paid Claims for September 2018

September 2018 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 9/1/2018)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 9/1/2018)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 9/1/2018)
Explanation of Benefits Report (Effective 9/10/2018)
- EOBs on Denied Claims for August 2018
- EOBs on Paid Claims for August 2018

August 2018 Data Tables

Diagnosis Restricted Drugs (Effective 7/1/2018)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 7/1/2018)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 8/1/2018)
Quantity Limit Drugs and Diabetic Supplies (Effective 8/1/2018)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 8/1/2018)
Explanation of Benefits Report (Effective 8/10/2018)
- EOBs on Denied Claims for July 2018
- EOBs on Paid Claims for July 2018

July 2018 Data Tables

Early Refill Drug Utilization Review Drugs (Effective 3/1/2018)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 7/1/2018)
Quantity Limit Drugs and Diabetic Supplies (Effective 7/1/2018)
Three-Month Supply Drugs (Effective 6/1/2017)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 7/1/2018)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 7/2/2018)
Explanation of Benefits Report (Effective 7/10/2018)
- EOBs on Denied Claims for June 2018
- EOBs on Paid Claims for June 2018

June 2018 Data Tables

Diagnosis Restricted Drugs (Effective 4/1/2018)
Expedited Emergency Supply Request Drugs (Published 12/20/2017)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 6/1/2018)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 6/1/2018)
Quantity Limit Drugs and Diabetic Supplies (Effective 6/1/2018)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 6/1/2018)
Explanation of Benefits Report (Effective 6/10/2018)
- EOBs on Denied Claims for May 2018
- EOBs on Paid Claims for May 2018

May 2018 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 5/1/2018)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 5/1/2018)
Quantity Limit Drugs and Diabetic Supplies (Effective 5/1/2018)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 5/1/2018)
Explanation of Benefits Report (Effective 5/10/2018)
- EOBs on Denied Claims for April 2018
- EOBs on Paid Claims for April 2018

April 2018 Data Tables

Over-the-Counter Drugs
- Covered by HealthCheck "Other Services" (Effective 4/1/2014)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 4/1/2018)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 4/1/2018)
Quantity Limit Drugs and Diabetic Supplies (Effective 3/1/2018)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 4/1/2018)
Explanation of Benefits Report (Effective 4/10/2018)
- EOBs on Denied Claims for March 2018
- EOBs on Paid Claims for March 2018

March 2018 Data Tables

Diagnosis Restricted Drugs (Effective 3/1/2018)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 2/1/2018)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 3/1/2018)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 3/1/2018)
Explanation of Benefits Report (Effective 3/10/2018)
- EOBs on Denied Claims for February 2018
- EOBs on Paid Claims for February 2018

February 2018 Data Tables

Diagnosis Restricted Drugs (Effective 2/1/2018)
Early Refill Drug Utilization Review Drugs (Effective 8/1/2016)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 2/1/2018)
Quantity Limit Drugs and Diabetic Supplies (Effective 1/1/2017)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 2/1/2018)
Explanation of Benefits Report (Effective 2/10/2018)
- EOBs on Denied Claims for January 2018
- EOBs on Paid Claims for January 2018

January 2018 Data Tables

Diagnosis Restricted Drugs (Effective 1/1/2018)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 1/1/2018)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 1/1/2018)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 1/1/2018)
Explanation of Benefits Report (Effective 1/10/2018)
- EOBs on Denied Claims for December 2017
- EOBs on Paid Claims for December 2017

December 2017 Data Tables

Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Effective 2/1/2016)
Diagnosis Restricted Drugs
Expedited Emergency Supply Request Drugs (Published 6/16/2017)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 12/1/2017)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 12/1/2017)
Quantity Limit Drugs and Diabetic Supplies (Effective 12/1/2017)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 12/1/2017)
Explanation of Benefits Report (Effective 12/10/2017)
- EOBs on Denied Claims for November 2017
- EOBs on Paid Claims for November 2017

November 2017 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 11/1/2017)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 11/1/2017)
Quantity Limit Drugs and Diabetic Supplies (Effective 11/1/2017)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 11/1/2017)
Explanation of Benefits Report (Effective 11/10/2017)
- EOBs on Denied Claims for October 2017
- EOBs on Paid Claims for October 2017

October 2017 Data Tables

Diagnosis Restricted Drugs
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 10/1/2017)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 10/1/2017)
Quantity Limit Drugs and Diabetic Supplies (Effective 10/1/2017)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 10/1/2017)
Explanation of Benefits Report (Effective 10/10/2017)
- EOBs on Denied Claims for September 2017
- EOBs on Paid Claims for September 2017

September 2017 Data Tables

Diagnosis Restricted Drugs
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 9/1/2017)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 9/1/2017)
Quantity Limit Drugs and Diabetic Supplies (Effective 9/1/2017)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 9/1/2017)
Explanation of Benefits Report (Effective 9/10/2017)
- EOBs on Denied Claims for August 2017
- EOBs on Paid Claims for August 2017

August 2017 Data Tables

Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 8/25/2017)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 8/1/2017)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 8/10/2017)
Revised 8/23/2017: Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 8/10/2017)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 8/1/2017)
Quantity Limit Drugs and Diabetic Supplies (Effective 7/1/2017)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 8/1/2017)
Explanation of Benefits Report (Effective 8/10/2017)
- EOBs on Denied Claims for July 2017
- EOBs on Paid Claims for July 2017

July 2017 Data Tables

Diagnosis Restricted Drugs
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 7/1/2017)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 7/1/2017)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 7/1/2017)
Explanation of Benefits Report (Effective 7/10/2017)
- EOBs on Denied Claims for June 2017
- EOBs on Paid Claims for June 2017

June 2017 Data Tables

Diagnosis Restricted Drugs
Expedited Emergency Supply Request Drugs (Published 3/15/2017)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 6/1/2017)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 6/7/2017)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 6/1/2017)
Quantity Limit Drugs and Diabetic Supplies (Effective 6/1/2017)
Quantity Limit Drugs and Diabetic Supplies (Effective 6/7/2017)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 6/1/2017)
Explanation of Benefits Report (Effective 6/10/2017)
- EOBs on Denied Claims for May 2017
- EOBs on Paid Claims for May 2017

May 2017 Data Tables

Diagnosis Restricted Drugs
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 5/1/2017)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 5/1/2017)
Quantity Limit Drugs and Diabetic Supplies (Effective 5/1/2017)
Three-Month Supply Drugs (Effective 4/1/2016)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 5/1/2017)
State and Specialty Pharmacy Drug Reimbursement Rates (Effective 5/24/2017)
Explanation of Benefits Report (Effective 5/10/2017)
- EOBs on Denied Claims for April 2017
- EOBs on Paid Claims for April 2017

April 2017 Data Tables

Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 4/1/2017)
Quantity Limit Drugs and Diabetic Supplies (Effective 2/1/2017)
Brand Medically Necessary Drugs and Brand Before Generic Drugs (Effective 4/1/2017)
Revised 4/12/2017: State and Specialty Pharmacy Drug Reimbursement Rates (Effective 4/1/2017)
Explanation of Benefits Report (Effective 4/10/2017)
- EOBs on Denied Claims for March 2017
- EOBs on Paid Claims for March 2017

March 2017 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Published 12/16/2016)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 3/1/2017)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 3/10/2017)
- EOBs on Denied Claims for February 2017
- EOBs on Paid Claims for February 2017

February 2017 Data Tables

State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 2/1/2017)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 2/10/2017)
- EOBs on Denied Claims for January 2016
- EOBs on Paid Claims for January 2016

January 2017 Data Tables

Diagnosis Restricted Drugs
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 1/1/2017)
Quantity Limit Drugs and Diabetic Supplies (Effective 11/1/2016)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 1/10/2017)
- EOBs on Denied Claims for December 2016
- EOBs on Paid Claims for December 2016

December 2016 Data Tables

Diagnosis Restricted Drugs
Expedited Emergency Supply Request Drugs (Published 6/17/2016)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 12/1/2016)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 12/10/2016)
- EOBs on Denied Claims for November 2016
- EOBs on Paid Claims for November 2016

November 2016 Data Tables

State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 11/1/2016)
Explanation of Benefits Report (Effective 11/10/2016)
- EOBs on Denied Claims for October 2016
- EOBs on Paid Claims for October 2016

October 2016 Data Tables

State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 10/1/2016)
Quantity Limit Drugs and Diabetic Supplies (Effective 10/1/2016)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 10/10/2016)
- EOBs on Denied Claims for September 2016
- EOBs on Paid Claims for September 2016

September 2016 Data Tables

State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 9/1/2016)
Quantity Limit Drugs and Diabetic Supplies (Effective 9/1/2016)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 9/10/2016)
- EOBs on Denied Claims for August 2016
- EOBs on Paid Claims for August 2016

August 2016 Data Tables

Diagnosis Restricted Drugs
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 8/1/2016)
Quantity Limit Drugs and Diabetic Supplies (Effective 8/1/2016)
- Revised 8/8/2016: Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 8/10/2016)
- EOBs on Denied Claims for July 2016
- EOBs on Paid Claims for July 2016

July 2016 Data Tables

Diagnosis Restricted Drugs
Early Refill Drug Utilization Review Drugs (Effective 4/1/2016)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 7/1/2016)
Quantity Limit Drugs and Diabetic Supplies (Effective 7/1/2016)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 7/10/2016)
- EOBs on Denied Claims for June 2016
- EOBs on Paid Claims for June 2016

June 2016 Data Tables

Diagnosis Restricted Drugs
Early Refill Drug Utilization Review Drugs (Effective 8/1/2015)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Published 1/1/2016)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 6/1/2016)
Quantity Limit Drugs and Diabetic Supplies (Effective 6/1/2016)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 6/10/2016)
- EOBs on Denied Claims for May 2016
- EOBs on Paid Claims for May 2016

May 2016 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 5/1/2016)
Quantity Limit Drugs and Diabetic Supplies (Effective 5/1/2016)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 5/10/2016)
- EOBs on Denied Claims for April 2016
- EOBs on Paid Claims for April 2016

April 2016 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 4/1/2016)
Quantity Limit Drugs and Diabetic Supplies (Effective 4/1/2016)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 4/10/2016)
- EOBs on Denied Claims for March 2016
- EOBs on Paid Claims for March 2016

March 2016 Data Tables

Early Refill Drug Utilization Review Drugs (Effective 8/1/2015)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 3/1/2016)
Quantity Limit Drugs and Diabetic Supplies (Effective 2/1/2016)
Specialty Pharmacy Drug Reimbursement Rates
Three-Month Supply Drugs (Effective 7/1/2014)
Explanation of Benefits Report (Effective 3/10/2016)
- EOBs on Denied Claims for February 2016
- EOBs on Paid Claims for February 2016

February 2016 Data Tables

Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 2/1/2016)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 2/10/2016)
- EOBs on Denied Claims for January 2016
- EOBs on Paid Claims for January 2016

January 2016 Data Tables

Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Effective 2/1/2016)
Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 1/1/2016)
Quantity Limit Drugs and Diabetic Supplies (Effective 1/1/2016)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 1/10/2016)
- EOBs on Denied Claims for December 2015
- EOBs on Paid Claims for December 2015

December 2015 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Published 7/2/2015)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Quantity Limit Drugs and Diabetic Supplies (Effective 12/1/2015)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 12/10/2015)
- EOBs on Denied Claims for November 2015
- EOBs on Paid Claims for November 2015

November 2015 Data Tables

Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 12/1/2015)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 11/1/2015)
Quantity Limit Drugs and Diabetic Supplies (Effective 10/1/2015)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 11/10/2015)
- EOBs on Denied Claims for October 2015
- EOBs on Paid Claims for October 2015

October 2015 Data Tables

Diagnosis Restricted Drugs
- Revised 10/2/2015: Diagnosis Restricted Drugs
- Revised 10/6/2015: Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 10/1/2015)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 10/10/2015)
- EOBs on Denied Claims for September 2015
- EOBs on Paid Claims for September 2015

September 2015 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 9/1/2015)
Quantity Limit Drugs and Diabetic Supplies (Effective 8/1/2015)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 9/10/2015)
- EOBs on Denied Claims for August 2015
- EOBs on Paid Claims for August 2015

August 2015 Data Tables

Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 8/1/2015)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 8/10/2015)
- EOBs on Denied Claims for July 2015
- EOBs on Paid Claims for July 2015

July 2015 Data Tables

Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Effective 5/1/2015)
Early Refill Drug Utilization Review Drugs (Effective 2/1/2015)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 7/1/2015)
Quantity Limit Drugs and Diabetic Supplies (Effective 7/1/2015)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 6/10/2015)
- EOBs on Denied Claims for June 2015
- EOBs on Paid Claims for June 2015

June 2015 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Published 4/16/2015)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 6/1/2015)
Quantity Limit Drugs and Diabetic Supplies (Effective 5/1/2015)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 6/10/2015)
- EOBs on Denied Claims for May 2015
- EOBs on Paid Claims for May 2015

May 2015 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 5/1/2015)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 5/10/2015)
- EOBs on Denied Claims for April 2015
- EOBs on Paid Claims for April 2015

April 2015 Data Tables

Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Effective 3/1/2015)
- Covered by HealthCheck "Other Services" (Effective 4/1/2014)
Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Published 12/18/2014)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 4/1/2015)
Quantity Limit Drugs and Diabetic Supplies (Effective 4/1/2015)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 4/10/2015)
- EOBs on Denied Claims for March 2015
- EOBs on Paid Claims for March 2015

March 2015 Data Tables

Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 3/1/2015)
Quantity Limit Drugs and Diabetic Supplies (Effective 2/1/2015)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 3/10/2015)
- EOBs on Denied Claims for February 2015
- EOBs on Paid Claims for February 2015

February 2015 Data Tables

Over-the-Counter Drugs
- Revised 1/26/2015: Covered (BadgerCare Plus and Medicaid) (Effective 12/1/2014)
Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 2/1/2015)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 2/10/2015)
- EOBs on Denied Claims for January 2015
- EOBs on Paid Claims for January 2015

January 2015 Data Tables

Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Effective 12/1/2014)
Diagnosis Restricted Drugs
Early Refill Drug Utilization Review Drugs (Effective 1/1/2015)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF Revised 1/2/2015
- PDF
- Excel Revised 1/2/2015
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 1/1/2015)
Quantity Limit Drugs and Diabetic Supplies (Effective 1/1/2015)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 1/10/2015)
- EOBs on Denied Claims for December 2014
- EOBs on Paid Claims for December 2014

December 2014 Data Tables

Diagnosis Restricted Drugs
Early Refill Drug Utilization Review Drugs (Effective 11/1/2014)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Published 6/10/2014)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 12/1/2014)
Quantity Limit Drugs and Diabetic Supplies (Effective 12/1/2014)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 12/10/2014)
- EOBs on Denied Claims for November 2014
- EOBs on Paid Claims for November 2014

November 2014 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 11/1/2014)
Quantity Limit Drugs and Diabetic Supplies (Effective 10/1/2014)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 11/10/2014)
- EOBs on Denied Claims for October 2014
- EOBs on Paid Claims for October 2014

October 2014 Data Tables

Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Effective 11/1/2013)
Early Refill Drug Utilization Review Drugs (Effective 1/1/2014)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 10/1/2014)
Quantity Limit Drugs and Diabetic Supplies (Effective 10/1/2014)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 10/10/2014)
- EOBs on Denied Claims for September 2014
- EOBs on Paid Claims for September 2014

September 2014 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 9/1/2014)
Quantity Limit Drugs and Diabetic Supplies (Effective 9/1/2014)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 9/10/2014)
- EOBs on Denied Claims for August 2014
- EOBs on Paid Claims for August 2014

August 2014 Data Tables

Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 8/1/2014)
Quantity Limit Drugs and Diabetic Supplies (Effective 8/1/2014)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 8/10/2014)
- EOBs on Denied Claims for July 2014
- EOBs on Paid Claims for July 2014

July 2014 Data Tables

Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 7/1/2014)
Quantity Limit Drugs and Diabetic Supplies (Effective 7/1/2014)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 7/10/2014)
- EOBs on Denied Claims for June 2014
- EOBs on Paid Claims for June 2014

June 2014 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Published 12/20/2013)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 6/1/2014)
Quantity Limit Drugs and Diabetic Supplies (Effective 6/1/2014)
Specialty Pharmacy Drug Reimbursement Rates
Three-Month Supply Drugs (Effective 10/1/2013)
Explanation of Benefits Report (Effective 6/10/2014)
- EOBs on Denied Claims for May 2014
- EOBs on Paid Claims for May 2014

May 2014 Data Tables

Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 5/1/2014)
Quantity Limit Drugs and Diabetic Supplies (Effective 3/1/2014)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 5/10/2014)
- EOBs on Denied Claims for April 2014
- EOBs on Paid Claims for April 2014

April 2014 Data Tables

Diagnosis Restricted Drugs
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 4/1/2014)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 4/10/2014)
- EOBs on Denied Claims for March 2014
- EOBs on Paid Claims for March 2014

March 2014 Data Tables

Diagnosis Restricted Drugs
Over-the-Counter Drugs
- Covered by HealthCheck "Other Services" (Effective 11/1/2013)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements (Effective 3/1/2014)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits Report (Effective 3/10/2014)
- EOBs on Denied Claims for February 2014
- EOBs on Paid Claims for February 2014

February 2014 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies (Effective 1/1/2014)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 2/10/2014)
- EOBs on Denied Claims for January 2014
- EOBs on Paid Claims for January 2014

January 2014 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Published 12/19/2013)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 1/10/2014)
- EOBs on Denied Claims for December 2013
- EOBs on Paid Claims for December 2013

December 2013 Data Tables

Diagnosis Restricted Drugs
Early Refill Drug Utilization Review Drugs (Effective 11/1/2013)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Effective 7/1/2013)
State Maximum Allowed Cost List (SMAC)
- PDF (Published on 12/9/2013)
- PDF (Published on 11/25/2013)
- Excel (Published on 12/9/2013)
- Excel (Published on 11/25/2013)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 12/10/2013)
- EOBs on Denied Claims for November 2013
- EOBs on Paid Claims for November 2013

November 2013 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies
- Published on 10/30/2013
- Published on 11/5/2013
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 11/10/2013)
- EOBs on Denied Claims for October 2013
- EOBs on Paid Claims for October 2013

October 2013 Data Tables

Diagnosis Restricted Drugs
Early Refill Drug Utilization Review Drugs (Effective 10/1/2012)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Effective 4/1/2013)
- Covered by HealthCheck "Other Services" (Effective 7/1/2013)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 10/10/2013)
- EOBs on Denied Claims for September 2013
- EOBs on Paid Claims for September 2013

September 2013 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies (Effective 7/1/2013)
Specialty Pharmacy Drug Reimbursement Rates
Three-Month Supply Drugs (Effective 7/1/2013)
Explanation of Benefits (Effective 9/10/2013)
- EOBs on Denied Claims for August 2013
- EOBs on Paid Claims for August 2013

August 2013 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Opioids Included in the Prescription Fill Limit (Effective 1/1/2011)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 8/10/2013)
- EOBs on Denied Claims for July 2013
- EOBs on Paid Claims for July 2013

July 2013 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 7/10/2013)
- EOBs on Denied Claims for June 2013
- EOBs on Paid Claims for June 2013

June 2013 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Over-the-Counter Drugs
- Covered by HealthCheck "Other Services" (Effective 1/1/2013)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates
Three-Month Supply Drugs (Effective 4/1/2012)
Explanation of Benefits (Effective 6/10/2013)
- EOBs on Denied Claims for May 2013
- EOBs on Paid Claims for May 2013

May 2013 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 5/10/2013)
- EOBs on Denied Claims for April 2013
- EOBs on Paid Claims for April 2013

April 2013 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 4/10/2013)
- EOBs on Denied Claims for March 2013
- EOBs on Paid Claims for March 2013

March 2013 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates
Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Effective 1/1/2013)
Explanation of Benefits (Effective 3/10/2013)
- EOBs on Denied Claims for February 2013
- EOBs on Paid Claims for February 2013

February 2013 Data Tables

Diagnosis Restricted Drugs
- Published on 2/12/2013
- Published on 1/29/2013
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies (Effective 1/1/2013)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 2/10/2013)
- EOBs on Denied Claims for January 2013
- EOBs on Paid Claims for January 2013

January 2013 Data Tables

Diagnosis Restricted Drugs
- Published on 1/14/2013
- Published on 12/27/2012
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 1/10/2013)
- EOBs on Denied Claims for December 2012
- EOBs on Paid Claims for December 2012

December 2012 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Published 11/1/2012)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Published 11/1/2012)
- HealthCheck "Other Services"
Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 12/10/2012)
- EOBs on Denied Claims for November 2012
- EOBs on Paid Claims for November 2012

November 2012 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Over-the-Counter Drugs
- HealthCheck "Other Services" (Published 7/1/2012)
Quantity Limit Drugs and Diabetic Supplies (Published 10/1/2012)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 11/10/2012)
- EOBs on Denied Claims for October 2012
- EOBs on Paid Claims for October 2012

October 2012 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Published 7/1/2012)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Published 8/1/2012)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 10/10/2012)
- EOBs on Denied Claims for September 2012
- EOBs on Paid Claims for September 2012

September 2012 Data Tables

Diagnosis Restricted Drugs
Early Refill Drug Utilization Review Drugs (Effective 5/1/2012)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 9/10/2012)
- EOBs on Denied Claims for August 2012
- EOBs on Paid Claims for August 2012

August 2012 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- Revised on 8/2/12 (PDF)
- Published on 7/26/12 (PDF)
- Published on 8/2/12 (Excel)
- Published on 7/26/12 (Excel)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 8/10/2012)
- EOBs on Denied Claims for July 2012
- EOBs on Paid Claims for July 2012

July 2012 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- Revised 7/5/2012 (PDF)
- Published on 6/22/2012 (PDF)
- Revised 7/5/2012 (Excel)
- Published on 6/22/2012 (Excel)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid)
Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 7/10/2012)
- EOBs on Denied Claims for June 2012
- EOBs on Paid Claims for June 2012

June 2012 Data Tables

Diagnosis Restricted Drugs (Published 3/1/2012)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Published 4/1/2012)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Published 12/1/2011)
- Covered by HealthCheck "Other Services" (Published 2/1/2012)
Quantity Limit Drugs and Diabetic Supplies (Published 5/3/2012)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 6/10/2012)
- EOBs on Denied Claims for May 2012
- EOBs on Paid Claims for May 2012

May 2012 Data Tables

Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies (Published 4/23/2012)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 5/10/2012)
- EOBs on Denied Claims for April 2012
- EOBs on Paid Claims for April 2012

April 2012 Data Tables

Early Refill Drug Utilization Review Drugs (Published 1/1/2012)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies (Published 3/1/2012)
Specialty Pharmacy Drug Reimbursement Rates
Three-Month Supply Drugs (Published 5/1/2011)
Explanation of Benefits (Effective 4/10/2012)
- EOBs on Denied Claims for March 2012
- EOBs on Paid Claims for March 2012

March 2012 Data Tables

Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Specialty Pharmacy Drug Reimbursement Rates
Three-Month Supply Drugs (Published 5/1/2011)
Explanation of Benefits (Effective 3/10/2012)
- EOBs on Denied Claims for February 2012
- EOBs on Paid Claims for February 2012

February 2012 Data Tables

Diagnosis Restricted Drugs (Published 1/1/2012)
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Published 1/1/2012)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies
- Published 1/27/2012
- Published 2/7/2012
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 2/10/2012)
- EOBs on Denied Claims for January 2012
- EOBs on Paid Claims for January 2012

January 2012 Data Tables

Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Over-the-Counter Drugs
- Covered by HealthCheck "Other Services" (Published 9/1/2011)
Quantity Limit Drugs and Diabetic Supplies (Published 11/1/2011)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 1/10/2012)
- EOBs on Denied Claims for December 2011
- EOBs on Paid Claims for December 2011

December 2011 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
Expedited Emergency Supply Request Drugs (Published 9/1/2011)
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Medications monitored by the Pharmacy Services Lock-In Program (Published 3/22/2011)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 12/10/2011)
- EOBs on Denied Claims for November 2011
- EOBs on Paid Claims for November 2011

November 2011 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Published 7/1/2011)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 11/10/2011)
- EOBs on Denied Claims for October 2011
- EOBs on Paid Claims for October 2011

October 2011 Data Tables

Diagnosis Restricted Drugs
Expanded Maximum Allowed Cost List (EMAC)
- PDF
- Excel
State Maximum Allowed Cost List (SMAC)
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 10/10/2011)
- EOBs on Denied Claims for September 2011
- EOBs on Paid Claims for September 2011

September 2011 Data Tables

Diagnosis Restricted Drugs
Maximum Allowed Cost List
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies (Effective 8/1/2011)
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 9/10/2011)
- EOBs on Denied Claims for August 2011
- EOBs on Paid Claims for August 2011

August 2011 Data Tables

Diagnosis Restricted Drugs
Expedited Emergency Supply Request Drugs
Maximum Allowed Cost List
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Over-the-Counter Drugs
- Covered by HealthCheck "Other Services"
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 8/10/2011)
- EOBs on Denied Claims for July 2011
- EOBs on Paid Claims for July 2011

July 2011 Data Tables

Diagnosis Restricted Drugs
Expedited Emergency Supply Request Drugs
Maximum Allowed Cost List
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Over-the-Counter Drugs
- Covered by HealthCheck "Other Services"
Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates
Explanation of Benefits (Effective 7/10/2011)
- EOBs on Denied Claims for June 2011
- EOBs on Paid Claims for June 2011

June 2011 Data Tables

Diagnosis Restricted Drugs
Expedited Emergency Supply Request Drugs (Published 4/1/2011)
Maximum Allowed Cost List
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Over-the-Counter Drugs
- Covered (BadgerCare Plus and Medicaid) (Published 1/1/2011)
- Covered by HealthCheck "Other Services" (Published 1/1/2011)
Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates (Published 4/1/2011)
Explanation of Benefits (Effective 6/10/2011)
- EOBs on Denied Claims for May 2011
- EOBs on Paid Claims for May 2011

May 2011 Data Tables

Diagnosis Restricted Drugs (Published 4/1/2011)
Maximum Allowed Cost List
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies (Published 4/1/2011)
Explanation of Benefits (Effective 5/10/2011)
- EOBs on Denied Claims for April 2011
- EOBs on Paid Claims for April 2011

April 2011 Data Tables

Maximum Allowed Cost List
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Three-Month Supply Drugs (Published 3/1/2011)
Explanation of Benefits (Effective 4/10/2011)
- EOBs on Denied Claims for March 2011
- EOBs on Paid Claims for March 2011

March 2011 Data Tables

Diagnosis Restricted Drugs
Maximum Allowed Cost List
- PDF (Published 3/8/2011)
- PDF (Published 3/1/2011)
- Excel (Published 3/8/2011)
- Excel (Published 3/1/2011)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies (Published 2/1/2011)
Specialty Pharmacy Drug Reimbursement Rates (Published 1/1/2011)
Explanation of Benefits (Effective 3/10/2011)
- EOBs on Denied Claims for February 2011
- EOBs on Paid Claims for February 2011

February 2011 Data Tables

Diagnosis Restricted Drugs
Maximum Allowed Cost List
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Three-Month Supply Drugs (Published 5/1/2010)
Explanation of Benefits (Effective 2/1/2011)
- EOBs on Denied Claims for January 2011
- EOBs on Paid Claims for January 2011

January 2011 Data Tables

Diagnosis Restricted Drugs
Maximum Allowed Cost List
- PDF
- Excel
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies

December 2010 Data Tables

Diagnosis Restricted Drugs (Published 11/1/10)
Maximum Allowed Cost List
- Sorted by Generic Name
- Sorted by BMN and Innovator
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies
Specialty Pharmacy Drug Reimbursement Rates

November 2010 Data Tables

Maximum Allowed Cost List
- Sorted by Generic Name
- Sorted by BMN and Innovator
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies (Published 10/1/2010)
Specialty Pharmacy Drug Reimbursement Rates (Published 10/01/10)

October 2010 Data Tables

Diagnosis Restricted Drugs (Published 8/1/2010)
Maximum Allowed Cost List
- Sorted by Generic Name
- Sorted by BMN and Innovator
Numeric Listing of Manufacturers That Have Signed Rebate Agreements

September 2010 Data Tables

Specialty Pharmacy Drug Reimbursement Rates
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies
Maximum Allowed Cost List
- Sorted by Generic Name
- Sorted by BMN and Innovator

August 2010 Data Tables

Specialty Pharmacy Drug Reimbursement Rates (Published 5/12/2010)
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies
Maximum Allowed Cost List
- Sorted by Generic Name
- Sorted by BMN and Innovator

July 2010 Data Tables

Diagnosis Restricted Drugs
Maximum Allowed Cost List
- Effective 7/15/2010
- Effective 7/1/2010
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Quantity Limit Drugs and Diabetic Supplies

June 2010 Data Tables

Brand Medically Necessary Drugs That Require Prior Authorization
Diagnosis Restricted Drugs
Early Refill Drug Utilization Review Drugs (Published 01/22/2010)
HealthCheck "Other Services" Covered by Wisconsin Medicaid Without Prior Authorization (Effective 3/1/10)
Legend Drug Maximum Allowed Cost List
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Over-the-Counter Maximum Allowed Cost List (Effective 5/1/10)
Quantity Limit Drugs and Diabetic Supplies

May 2010 Data Tables

Brand Medically Necessary Drugs That Require Prior Authorization
Diagnosis Restricted Drugs
- Published 5/11/10
- Published 5/17/2010
Legend Drug Maximum Allowed Cost List
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Specialty Pharmacy Drug Reimbursement Rates (Published 4/9/10)
Quantity Limit Drugs

April 2010 Data Tables

Brand Medically Necessary Drugs That Require Prior Authorization
Diagnosis Restricted Drugs
Legend Drug Maximum Allowed Cost List
Numeric Listing of Manufacturers That Have Signed Rebate Agreements
Over-the-Counter Maximum Allowed Cost List
- Published 4/7/2010
- Published 4/1/2010
Quantity Limit Drugs
Three-Month Supply Drugs (1/22/2010)

March 2010 Data Tables

February 2010 Data Tables

January 15 2010 Data Tables

December 2009 Data Tables

November 2009 Data Tables

October 2009 Data Tables

September 2009 Data Tables

August 2009 Data Tables

July 2009 Data Tables

June 2009 Data Tables

May 2009 Data Tables

April 2009 Data Tables

March 2009 Data Tables

February 2009 Data Tables

January 2009 Data Tables

December 2008 Data Tables

November 2008 Data Tables

October 2008 Data Tables

September 2008 Data Tables

August 2008 Data Tables

July 2008 Data Tables

June 2008 Data Tables

May 2008 Data Tables

April 2008 Data Tables

March 2008 Data Tables

February 2008 Data Tables

January 2008 Data Tables

December 2007 Data Tables

November 2007 Data Tables

October 2007 Data Tables

September 2007 Data Tables

August 2007 Data Tables

July 2007 Data Tables

June 2007 Data Tables

May 2007 Data Tables

April 2007 Data Tables

Legend Drug Maximum Allowed Cost List

March 2007 Data Tables

February 2007 Data Tables

January 2007 Data Tables

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