LETTER TO PHARMACISTS
October 20, 2005
Dear Pharmacy
Provider:
RE: PDL # 05-02
Monthly Script Limit
Attached is the
complete, most current listing of drugs on the Medicaid Prior Authorization (PA)
Process' Preferred Drug List (PDL) "05-02." The listing includes preferred drugs and those drugs requiring prior
authorization. This
list will be effective November 1, 2005.
The PA process,
in accordance with the program's "Continuity of Care" policy, does not
impact original prescriptions (or refills) issued by a prescribing practitioner
prior to effective PA dates of drugs as they are added to the PA process as
long as they are within the 5 refills and 6-month program limits. An
educational alert will notify the pharmacist that prescriptions (and their
refills) will require a new prescription and prior authorization, if the
prescription life exceeds six months or the refill exceeds the 5 refill limit.
The educational alert will state, "NEW RX WILL REQUIRE PA AFTER (DATE).
Information on
the Prior Authorization process, including the PDL and Prior Authorization
Request Form (copy is attached, Form RXPA01), is also available on the Louisiana
Medicaid website (www.lamedicaid.com).
This website will be updated when changes (additions or deletions) are made to
the PDL. The program may also utilize the provider remittance advices to notify
providers of PDL changes that must be implemented in short time frames.
The Department
has received inquiries that drug products requiring PA are not reimbursable by
Medicaid. Medicaid does reimburse for drug products requiring prior
authorization when the prior authorization process is followed. Additionally, should a claim deny because a PA is required, you may want
to 1) verify that the PA was actually obtained and the dates of service for the
PA; 2) verify that the filling date on the claim is subsequent to the start date
of the PA. (Remember: PAs are not retroactive); and 3) call the POS help desk at 1-800-648-0790
for further assistance.
Act 177 of the 2005 Regular Session of the Louisiana Legislature authorizes
the Department of Health and Hospitals to review atypical antipsychotic and
hepatitis C drugs for placement on the Medicaid Preferred Drug List (PDL). These drugs were reviewed at the August 17, 2005, Pharmaceutical and
Therapeutics Committee meeting and are included on the current PDL #05-02. The legislation contains a "grandfathering" provision which provides
for the following: Medicaid recipients that have had a prescription filled for an atypical
antipsychotic or hepatitis C drug from May1 - October 31 (six months prior to
the effective date of the drug class being placed on the PDL) will not
need to obtain prior authorization for their drug if the drug that they are
currently taking should be non-preferred.
Hospital
Discharge Prescriptions for Atypical Antipsychotics: When a recipient is
discharged from a hospital with a prescription for an atypical antipsychotic
prescription, the prescribing practitioner must indicate on the face of the
prescription, if hard copy, that the prescription is
a "Hospital Discharge" or if
the prescription is called in to the pharmacy, the "Hospital Discharge"
status of the prescription must be communicated to the pharmacist who must
indicate " Hospital Discharge" on the hard copy prescription.
In situations where the prescribing
practitioner is unavailable and the pharmacist determines the prescription is a
"Hospital Discharge" prescription, the pharmacist must indicate "Hospital
Discharge" on the hard copy prescription.
Claims for "Hospital Discharge"
prescriptions needing prior authorization (PA) will be submitted using the same
process used for an emergency override. The pharmacist must code the claim as an
emergency prescription (enter "03" in NCPDP Field 418-DI - Level of
Service). An NCPDP educational
alert will notify the pharmacist that the drug requires prior authorization.
Prescriptions for
"Hospital Discharge" products shall be dispensed in a MINIMUM quantity of a
3-day supply, and refills for the
dispensing of the non-preferred
products are not permitted. The
recipient's practitioner must contact the Prior Authorization Unit to request
authorization to continue the medication past the "Hospital Discharge"
supply, and a new prescription must be issued.
DHH will monitor emergency
prescriptions/recipients on an ongoing basis through management reports,
pharmacy provider audits, and other review programs to review the number of
these prescriptions and the reasons for them.
Monthly
Script Limit
The monthly script limit edit was
temporarily suspended for Hurricane Katrina. Please note that effective November 1, 2005, the monthly script limit
edit will be reactivated.
Thank you for your continued cooperation. We
appreciate your participation in the Medicaid Program.
Sincerely,
Ben A. Bearden
Medicaid Director
BAB/mjt/ht
Attachments (2)
The above letter and the Preferred Drug
List are
also available in PDF format on the Downloadable
Forms and Files page.