Provider Notice issued 04/24/13

Long Term Care Residents Restricted to 14-Day Supplies of Certain Medications

As a result of Public Act 097-0689(pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, HFS is implementing edits to restrict dispensing of certain medications to 14-day supplies for nursing home residents.

Effective May 1, 2013, specific brand-name, solid oral drugs dispensed to patients residing in any facility that provides medical group care services as defined in 89 Illinois Administrative Code, Section 140.500, except Intermediate Care Facilities for the Developmentally Disabled (ICF/DD) and supportive living facilities (SLF), must be dispensed in 14-day supplies. Solid oral doses of antibiotics and drugs that are dispensed in their original container as indicated in the Food and Drug Administration Prescribing Information, or that are customarily dispensed in their original packaging to assist patients with compliance, are excluded from this requirement and may be dispensed in supplies greater than 14 days.

A list of the drugs required to be dispensed to nursing facility residents in a 14-day supply is available on the department's Long Term Care Pharmacy Information web page. Pharmacy claims that contain a quantity greater than a 14-day supply for drugs on the list will reject with the error message G58 - "LTC Limited to 14 Day Supply per Fill." The department will pay only one dispensing fee per 28 days' supply for drugs dispensed in accordance with this requirement.

Any questions regarding this notice should be directed to the Bureau of Pharmacy Services at 1-877-782-5565, option 7.

Theresa A. Eagleson, Administrator

Division of Medical Programs