RA Messages for October 27, 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
GLIPIZIDE  TAB SA OSM  2.5MG   10/04/99
QUINUPRISTINL DALFOPRISTIN VIAL 500MG   09/22/99
RAPACURONUM BROMIDE VIAL 100MG   10/04/99
SIROLIMUS SOLUTION 1MG/ML   09/20/99
SOMATROPIN CARTRIDGE 0.2,0.4,0.6,0.8,1MG   10/02/99

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 WRITTEN 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 PHARMACISTS AND PHYSICIANS

EFFECTIVE FOR SERVICES BEGINNING OCTOBER 26, 1999, THE BUREAU OF HEALTH SERVICES FINANCING WILL BEGIN REIMBURSING FOR THE FOLLOWING ANTIHISTAMINE/DECONGESTANT PRODUCTS FOR THE MEDICALLY APPROVED INDICATION OF  ALLERGIC RHINITIS (SEASONAL OR PERENNIAL). PLEASE BE REMINDED THAT IN ACCORDANCE WITH SECTION 1927 (D)(2) OF THE SOCIAL SECURITY ACT, THE  MEDICAID AGENCY IS ALLOWED TO EXCLUDE COVERAGE OF DRUGS OR CLASSES OF DRUGS CONTAINING COUGH AND COLD AGENTS WHEN THOSE PRODUCTS ARE PRESCRIBED FOR THE TREATMENT OF COUGH AND COLDS. IN ADDITION, THE DEPARTMENT WILL COMMENCE DRUG UTILIZATION REVIEWS ON A RETROSPECTIVE BASIS AS WELL AS DEVELOP PROSPECTIVE DRUG UTILIZATION CRITERIA TO REDUCE THERAPEUTIC DUPLICATION OF ANTIHISTAMINE PRODUCTS AND/OR CONCURRENT THERAPY WITH OTHER ANTIHISTAMINE/DECONGESTANT PRODUCTS.                         

                       GENERIC DESCRIPTION                             

ACRIVASTINE AND PSEUDOEPHEDRINE                                        

AZATADINE AND PSEUDOEPHEDRINE                                          

BROMPHENIRAMINE AND PHENYLEPHRINE                                      

BROMPHENIRAMINE,PHENYLEPHRINE AND PHENYLPROPANOLAMINE                  

BROMPHENIRAMINE AND PSEUDOEPHEDRINE                                    

CARBINOXAMINE AND PSEUDOEPHEDRINE                                      

CHLORPHENIRAMINE,PHENINDAMINE AND PHENYLPROPANOLAMINE                 

CHLORPHENIRAMINE AND PHENYLEPHRINE                                    

CHLORPHENIRAMINE, PHENYLEPHRINE AND PHENYLPROPANOLAMINE               

CHLORPHENIRAMINE AND PHENYLPROPANOLAMINE                              

CHLORPHENIRAMINE,PHENYLTOLOXAMINE AND PHENYLEPHRINE                   

CHLORPHENIRAMINE,PHENYLTOLOXAMINE,PHENYLEPHRINE AND PHENYLPROPANOLAMINE

CHLORPHENIRAMINE AND PSEUDOEPHEDRINE                                   

CHLORPHENIRAMINE,PYRILAMINE,PHENYLEPHRINE AND PHENYLPROPANOLAMINE     

CLEMASTINE AND PHENYLPROPANOLAMINE                                    

DEXBROMPHENIRAMINE AND PSEUDOEPHEDRINE                                

DIPHENHYDRAMINE AND PSEUDOEPHEDRINE                                   

FEXOFENADINE AND PSEUDOEPHEDRINE                                      

LORATADINE AND PSEUDOEPHEDRINE                                        

PHENIRAMINE AND PHENYLEPHRINE                                         

PHENIRAMINE,PHENYLTOLXAMINE,PYRILAMINE AND PHENYLPROPANOLAMINE        

PHENIRAMINE, PYRILAMINE AND PHENYLPROPANOLAMINE                       

PROMETHAZINE AND PHENYLEPHRINE                                        

TRIPROLIDINE AND PSEUDOEPHEDRINE                                       

CHLORPHENIRAMINE,PHENYLEPHRINE AND METHSCOPOLAMINE                    

CHLORPHENIRAMINE,PHENYLEPHRINE,PHENYLPROPANOLAMINE,ATROP,HYOSCY,SCOPOLAM

CHLORPHENIRAMINE,PHENYLPROPANOLAMINE AND METHSCOPOLAMINE               

CHLORPHENIRAMINE,PSEUDOEPHEDRINE AND METHSCOPOLAMINE  

EMC TESTING

THE UNISYS EMC DEPARTMENT IS UNDERGOING TESTING TO ENSURE THAT EMC SUBMISSIONS ARE Y2K READY.  EMC VENDORS AND SUBMITTERS WILL NOT CHANGE THE PROCESS CURRENTLY BEING USED TO SUBMIT EMC CLAIMS TO UNISYS.  ALL REQUIRED CHANGES ARE BEING MADE BY UNISYS WITHIN MMIS TO CONVERT NECESSARY DATA TO Y2K STATUS.  IF YOU RELY ON ANOTHER ENTITY (I.E., BILLING SERVICE CLEARINGHOUSE) TO BILL CLAIMS OR RECONCILE ACCOUNTS ON YOUR BEHALF, PLEASE SHARE THIS INFORMATION WITH THEM.  IF ENTITIES ARE NOT INFORMED AND/OR NOT Y2K READY, IT MAY CAUSE DIFFICULTY FOR YOU.