Pharmacy
By
Feb 20, 2026
The 2026 Pharmacy Provider Manual was last updated on December 20, 2025. See the table below for an at-a-glance view of the changes to specific sections.
Summary of Changes & Reminders
Section #
Section Update or Addition
Update Summary
3.1
Update
Added new BIN/PCN Combinations
4.4
Update
Clarification on non-covered ingredients
5.3
Update
New MAC List accessibility process
8.0
Update
New payment and reconciliation vendor and processes
9.11
Update
Medicare Service Areas for 2026
9.12
Addition
Medicare Drug Price Negotiation
9.13
Addition
Medicare Transaction Facilitator
5.5, 10.5, 10.6, 10.7
Additions
Utah Medicaid Reimbursement Methodology
Appendix A
Update
Added additional state resources
Appendix B
Update
Full replacement for 2026
Appendix C
Update
Full replacement for 2026
Important Medicare Billing Information
For claims with a date of service:
Before January 1, 2026
Please use
BIN 015938 PCN 7463 /
BIN 027357 PCN MPPP.
On or After January 1, 2026
Please use
BIN 028645 PCN 7463 /
BIN 028645 PCN MPPP.
Reference the payer sheet in the Pharmacy Provider Manual (Appendix B) for full details on billing Medicare claims.