Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 09/20/04

Emergency Supply of Covered Prescription Drugs

To:​ Participating Hospitals and Pharmacies​
Date:​ September 20, 2004​
Re:​

Emergency Supply of Covered Prescription Drugs ​

 

The department wishes to remind pharmacy providers of the long-standing policy regarding payment for an emergency supply of covered prescription drugs. According to administrative rule, the department is required to render a decision on all prior approval requests by the same time on the department’s next business day. During non-business hours such as evenings, weekends and state holidays when Department staff are not available to accept a prior approval request, the pharmacy can dispense and the department will pay for an emergency 72-hour supply of a covered prescription drug to an eligible recipient in an emergency situation. The pharmacy is responsible for following up with a prior approval request for the emergency supply and for on-going refills of the prescription.

 

In order to receive reimbursement for the emergency 72-hour supply, the pharmacy must submit a separate prior approval request that clearly states the request is for the emergency 72-hour supply of the drug. The request must include the quantity dispensed for the 72-hour supply. Please note that prior approval requests for emergency supplies should not be submitted using the department’s Automated Voice Response System (AVRS) since providers do not have the ability in AVRS to indicate that the request is for an emergency supply.

 

Prior approval requests can be submitted to the department in a variety of ways. The department strongly encourages pharmacies to utilize the NCPDP 5.1 electronic format or AVRS at 1-800-642-7588 when submitting prior approval requests. If one of these systems cannot be utilized, prior approval requests can be faxed to 217-524-7264 or 217-524-0404 or phoned in to the department’s prior approval hotline at 1-800-252-8942.

 

If you have any questions concerning this notice, you may contact a pharmacy billing representative by calling 217-782-5565 and selecting Option 7 for the Pharmacy Program.

 

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs