The files below include the Georgia Maximum Allowable Cost (GMAC) and Select Specialty Pharmacy Rates (SSPR) which identifies the maximum reimbursement for each product. Products listed will be reimbursed at the GMAC or SSPR unless the prescriber receives prior approval for the brand name drug.

 

Including a product on the GMAC or SSPR list does not constitute automatic coverage for all recipients. For instance, Niacin and Vitamin B with C are covered only for patients with end stage renal disease.

 

For procedural questions, contact OptumRx Technical Assistance Help Desk at (866) 525-5826.

 

NOTE: This list is for the Medicaid program and is not the preferred drug list for the State Health Benefit Plan or the Board of Regents Health Plan pharmacy programs.

Please reverse and resubmit affected claims in order to be reimbursed at a higher pricing level. Reprocessed claim adjustments can be seen in upcoming remittance advices. For procedural questions, contact OptumRx Technical Assistance Help Desk at (866) 525-5826.

 

Please share this information with appropriate staff. If you are the corporate office of a chain pharmacy, please provide this information to each of your stores located in Georgia. If you have additional questions or concerns regarding this notification, please contact Pharmacy Services at (404) 656-4044.

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