June 20, 2008 - Reminder: 72-Hour Emergency Overrides of PA-Required Drugs
Federal and state law require that a 72-hour emergency supply of a prescribed drug be provided to Medicaid clients when medication is needed without delay and prior authorization (PA) is not available. The rule applies to non-preferred drugs on the Preferred Drug list and any drug that is affected by a clinical or PA edit that would need prescriber prior approval.
The 72-hour emergency supply should be dispensed any time a prior authorization is not available and a prescription must be filled, for any medications or medical condition. If the prescribing provider cannot be reached or is unable to request a PA, the pharmacy should submit an emergency 72-hour prescription. The 72-hour emergency procedure should not be used for routine and continuous overrides.
To submit a claim, pharmacies should supply the following information:
q An ‘8’ in ‘Prior Authorization Type Code’ (Field 461-EU)
q An ‘8Ř1’ in ‘Prior Authorization Number Submitted’ (Field 462-EV)
q A ‘3’ in ‘Days Supply’ in the claim segment of the billing transaction (Field 4Ř4-D5)
q The quantity submitted in “Quantity Dispensed” (Field 442-E7) should not exceed the quantity necessary for a three-day supply according to the directions for administration given by the prescriber. If the medication is a dosage form that prevents a three-day supply from being dispensed, e.g., an inhaler, it is still permissible to indicate that the emergency prescription is a three-day supply, and enter the full quantity dispensed.
Vendor Drug sent laminated copies of the pharmacy guide with the 72-hour emergency prescription instructions in both full-page and index card size versions to all contracted pharmacies in December 2007. Pharmacists are encouraged to post these instructions in your pharmacy for reference and to reproduce this information for staff education. It is very important that your staff understands the 72-hour emergency supply policy and procedures and uses it appropriately.
Additional copies of the instructions are online and available for downloading at:
If you are a pharmacy provider that contracts with Vendor Drug and did not receive a copy of the 72-hour instructions in the mail, please check to ensure your address on file with Vendor Drug is correct. Changes in address should be reported to the Medicaid/CHIP Contract Management unit in accordance with the Terms and Conditions of the Medicaid contract. Please submit corrections by fax to (512) 491-1971.
For more information about the Vendor Drug Program, please visit:
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