“It is comforting to know [Mountain Pacific] staff ‘get it’ and are not just reciting from a manual. It is very evident [they have] extensive pharmacy knowledge and experience.”
– Director of Pharmacy at a Montana Hospital
“Quick, logical responses make Mountain Pacific stand out as a prior authorization provider. As a taxpayer, I appreciate the state paying for a company that has customer service like that.”
– Pharmacist in Montana
“We interact on a regular basis with [Mountain Pacific] personnel, who have been extremely helpful in facilitating the best medical care for our Montana Medicaid patients.”
– Medical Director at a Montana Health Care Facility
Pharmacy
Medications can be expensive. And paired with other medications, they can also have significant side effects. Under contract with the Montana Department of Public Health and Human Services, Mountain Pacific employs pharmacists and certified pharmacy technicians to help make sure Montanans get the right medicines at the right time for the right reasons — and at the right price — to feel as healthy as possible.
Our expert pharmacists also
- support the Department for Medicaid, Mental Health Services Plan and the Healthy Montana Kids prescription programs as a policy advisor;
- provide all technical and administrative management duties of the Montana Medicaid Drug Use Review Board (DURB)/Formulary Committee, which comprises Montana physicians and pharmacists.
Many medications require prior authorization (PA) before pharmacists can provide them to their patients. Our expert team of pharmacist reviewers check medications for medical necessity and cost effectiveness before providing authorization. Providers can view a list of medications and their coverage below and contact our drug PA team for approval at 1-800-395-7961.
Mountain Pacific conducts drug utilization review. This means we collect, analyze, and interpret drug use patterns to improve the quality, safety, and economical use of medications in inpatient care. We review and study
- What drugs Montanans are being prescribed,
- How Montanans use those prescribed drugs and
- Evaluate the cost-effectiveness of these drug therapies using evidence-based guidelines.
We also publish a quarterly newsletter for almost 1,000 Montana health care providers and pharmacies. This newsletter offers education about our reviews of prescription drug use in Montana and updates on newly implemented clinical drug criteria.
As part of our drug utilization review services, Mountain Pacific also provides pharmacy case management services. Clinical pharmacists conduct telephone conferences with Medicaid providers and offer unbiased and evidence-based recommendations to assist providers in managing medications and patients’ illnesses. By sharing information and drug recommendations with health care providers, we ultimately help patients and reduce health care costs. With thousands of different medications available, sometimes a prescription drug needs to be prior-authorized before it will be covered by Medicaid. Mountain Pacific helps Montanans get the safest, most effective, and reasonably priced prescriptions by offering drug prior authorization services.
Our expert, call-center staff of pharmacists and certified pharmacy technicians provide expertise and data analysis to review prior authorization requests in support of
- The Medicaid Prescription Drug Program,
- The Medicaid Home Infusion Therapy Program,
- The Mental Health Services Plan Prescription Drug Program and
- The Healthy Montana Kids Prescription Plan.
We help develop criteria used to make decisions about authorizing medications. We also review prior authorization requests using Preferred Drug List categories established by the Drug Utilization Review Board. We coordinate our prior authorization activities with our drug utilization review activities to better serve providers and pharmacists.
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Mountain Pacific administers a prior authorization program for several physician-administered drugs (PAD) for Montana Healthcare Programs. Our clinical pharmacy team reviews a provider’s request for these complicated, often expensive treatments. Provider requests are submitted through our provider portal and routed to our pharmacy experts who review the claim to make sure it satisfies state drug utilization board requirements. Via the portal, providers can access the claim in real-time to track its progress. They also receive an email notification when a decision is made. This process ensures streamlined communication and reduces the burden on providers and their staff.
Providers can view a list of medications and their coverage below and contact our team for approval at 1-800-219-7035.
Aduhelm (aducanumab-avwa)
Amondys 45 (casimersen)
Cinqair (reslizumab)
Entyvio (vedolizumab)
Evenity (romosozumab-aqqg)
Evkeeza (evinacumab-dgnb)
Exondys 51 (eteplirsen)
Fasenra (benralizumab)
Ilumya (tildrakizumab-asmn)
Krystexxa (pegloticase)
Lemtrada (alemtuzumab)
Leqembi (lecanemab-irmb)
Leqvio (inclisiran)
Nucala (mepolizumab)
Prolia (denosumab)
Simponi Aria (golimumab infusion)
Skyrizi (risankizumab-rzaa)
Spinraza (nusinersen)
Spravato (esketamine)
Stelara (ustekinumab)
Sublocade (buprenorphine extended-release)
Supprelin LA (histrelin acetate)
Tezspire (tezepelumab)
Tremfya (guselkumab)
Tzield (teplizumab-mxwv)
Viltepso (viltolarsen)
Vivitrol (naltrexone extended-release)
Vyepti (eptinezumab-jjmr)
Vyondys 53 (golodirsen)
Xgeva (denosumab)
Xolair (omalizumab)
Zinplava (bezlotoxumab)
Zolgensma (onasemnogene abeparvovec-xioi)
Zulresso (brexanolone)