Resource Library

Utah Maximum Allowable Cost (UMAC)

Details regarding Utah Medicaid Pharmacy Reimbursement, UMAC Pharmacy Help Desk, and Rate Review are available on the Myers and Stauffer website.

National Average Drug Acquisition Cost (NADAC)

NADAC is published by the Centers for Medicare and Medicaid Services (CMS). Additional details and contact information for the NADAC Help Desk, is available at Medicaid.gov

Medically billed claims for provider administered drugs must contain the appropriate HCPCS code and the corresponding National Drug Code (NDC).

HCPCS coverage status can be verified by using the PRISM Coverage and Reimbursement Lookup Tool

NDC/HCPCS crosswalk details can be verified using the HCPCS/NDC Crosswalk Download

Requests to update or add HCPCS to NDC matches can be submitted using the Physician Administered Drug Request Form (located below)

Drugs greater than or equal to $1 million per dose require the Ultra-High-Cost Claim Submission Forms (located below)

Member Restriction Program

Utah Medicaid Information Bulletins

Utah Medicaid Provider Manuals

Utah Medicaid Pharmacy Provider Manual

Vaccines for Children (VFC) Provider Information

Please refer to the Drug Manufacturer Meeting Request Form (located below) for meeting guidelines and instructions on submitting a meeting request.