RA Messages for October 19, 1999
PHARMACY PROVIDERS, PLEASE NOTE!!!
IF YOU ARE
UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT THE PBM HELP DESK AT
1-800-648-0790
PLEASE
MAKE THE FOLLOWING CHANGES TO THE 8/15/98 VERSION OF APPENDIX A:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF.DATE |
| EPIRUBICIN HCL |
VIAL |
2MG/ML |
|
10/02/99 |
| ERYTHROMYCIN ESTOLATE |
CAPSULE |
250MG |
OFF MAC |
10/04/99 |
| FOLIC ACID |
TABLET |
1MG |
$0.03750 |
10/04/99 |
| IBUPROFEN |
TABLET |
400MG |
$0.16160 |
10/04/99 |
| IBUPROFEN |
TABLET |
600MG |
$0.22658 |
10/04/99 |
| IBUPROFEN |
TABLET |
800MG |
$0.29020 |
10/04/99 |
| LINDANE
|
LOTION
|
1% 60'S |
$0.09983
|
10/04/99 |
| LINDANE
|
LOTION
|
1% OTH SIZES |
OFF MAC |
10/04/99 |
| LINDANE
|
SHAMPOO
|
1% 60'S |
$0.09983 |
10/04/99 |
| LINDANE
|
SHAMPOO
|
1% OTH SIZES |
OFF MAC |
10/04/99 |
| MINOXIDIL |
TABLET |
2.5MG |
$0.33250 |
10/04/99 |
| MINOXIDIL |
TABLET |
10MG |
$0.54000 |
10/04/99 |
| PIROXICAM |
CAPSULE |
10MG |
$1.25750 |
10/04/99 |
| PIROXICAM |
CAPSULE |
20MG |
$2.15190 |
10/04/99 |
| RAPACURONUM BROMIDE |
VIAL |
100MG
|
|
10/04/99 |
| RANITIDINE HCL |
TABLET |
150MG |
$1.47150 |
10/04/99 |
| RANITIDINE HCL |
TABLET |
300MG |
$2.56672 |
10/04/99 |
| SOMATROPIN |
CARTRIDGE |
0.2,0.4,0.6,0.8,1MG |
|
10/02/99 |
| VALPROIC ACID |
CAPSULE |
250MG
|
$0.59000 |
10/04/99 |
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN
INCORRECTLY PAID
PHARMACY PROVIDERS
THE POS HELP DESK HAS RECEIVED INQUIRIES ASKING IF THE
MEDICAID PAYMENT AND DOCUMENTATION METHODOLOGY FOR MAC DRUGS HAS CHANGED BECAUSE
OF THE OCTOBER 1999 EDITION OF LOUISIANA BOARD OF PHARMACY NEWSLETTER.
THE MESSAGE IS TO ADVISE PHARMACISTS THAT THE PAYMENT
METHODOLOGY AND DOCUMENTATION
REQUIREMENTS ON MAC DRUG PRICING HAS NOT CHANGED. PLEASE CONSULT THE
PRESCRIPTION DRUG SERVICES MANUAL, PAGE 10-2 FOR A DISCUSSION OF BILLING
REQUIREMENTS FOR MAC DRUGS.
"IN ACCORDANCE WITH FEDERAL REGULATIONS, MAC PRICES
HAVE BEEN ASSIGNED FOR CERTAIN DRUGS....ANY DRUG WITH WHOLESALE COSTS EXCEEDING
THE MAC COSTS WILL BE REDUCED
TO MAC LIMITATIONS.
WHEN A PHYSICIAN CERTIFIES THAT A SPECIFIC BRAND IS
MEDICALLY NECESSARY FOR A PARTICULAR RECIPIENT,THEN THE MAC LIMITATIONS FOR THAT
MEDICATION WILL NOT APPLY. THE FOLLOWING GUIDELINES WILL APPLY IN THESE CASES:
A) THE CERTIFICATION MUST BE IN THE PHYSICIAN'S
HANDWRITING,
B) THE CERTIFICATION MAY BE WRITTRN
EITHER DIRECTLY ON THE PRESCRIPTION OR
ON A SEPERATE SHEET WHICH IS ATTACHED TO THE PRESCRIPTION,
C) THE STANDARD PHRASES WRITTEN BY
THE PRESCRIBER ON THE PRESCRIPTION SHOULD TESTIFY
TO THE MEDICAL NECESSITY OF THE BRANDNAME DRUG. THE ONLY ACCEPTABLE
PHRASES ARE 'BRAND NECESSARY' OR 'BRAND MEDICALLY NECESSARY' PHRASES SUCH AS 'DO
NOT SUBSTITUTE','NO GENERICS' OR 'DISPENSE AS WRITTEN'
ARE NOT ACCEPTABLE FOR OVERRIDING MAC LIMITATIONS. PROVIDERS SHOULD
VERIFY THAT THE APPROPRIATE WORDING IS PROPERLY DOCUMENTED AT THE
TIME OF DISPENSING. CHECKING A PRINTED BOX ON THE PRESCRIPTION TO INDICATE
THAT THE BRAND IS NECESSARY IS UNACCEPTABLE. A HANDWRITTEN STATEMENT
TRANSFERRED TO A RUBBER STAMP AND THEN STAMPED ON THE PRESCRIPTION
BLANK IS UNACCEPTABLE".
NOTICE TO PROVIDERS
THE FOLLOWING CODES HAVE BEEN MADE PAYABLE FOR CROSSOVER
CLAIMS EFFECTIVE WITH DATE OF SERVICE GIVEN:
| G0125 |
PET LUNG |
EFFECTIVE WITH DATE OF SERVICE 4/01/1998 |
| G0126 |
PET LUNG |
EFFECTIVE WITH DATE OF SERVICE 4/01/1998 |
| G0163 |
PET COLORECTAL |
EFFECTIVE WITH DATE OF SERVICE 7/01/1998 |
| G0164 |
PET LYMPHOMA |
EFFECTIVE WITH DATE OF SERVICE 7/01/1998 |
| G0165 |
PET MELANOMA |
EFFECTIVE WITH DATE OF SERVICE 7/01/1998 |
NOTICE TO HOSPITALS
ON JULY 30, 1999, A MEMORANDUM WAS ISSUED REGARDING OUTPATIENT CODING FOR PPS
DATA COLLECTION. IF YOU ARE SUBMITTING A CPT/HCPCS WITH A REVENUE CODE, DO
NOT SUBMIT THAT SAME REVENUE CODE WITHOUT A CPT/HCPCS ON THE SAME CLAIM FORM.
IF YOU DO, THE REVENUE CODE WITHOUT THE HCPCS WILL DENY.