Pharmacy Coverage. a. Pharmacy Coverage HMOs must carve out all SSA §1927 covered outpatient drugs to fee-for-service (covered outpatient drugs include drugs dispensed in a pharmacy, administered in a doctor’s office, or clinic; drugs reimbursed at bundled rate are not considered outpatient drugs). Per Article III, section C, the HMO must coordinate the services it provides to members with services a member receives through Medicaid Fee-for-Service.
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Samples: www.forwardhealth.wi.gov, www.forwardhealth.wi.gov, www.forwardhealth.wi.gov