Provider Notice issued 04/20/11

On July 29, 2010, Governor Pat Quinn signed into law Public Act 96-1372 (GA96 Senate Bill 326), historic reform legislation that established new standards of care for LTC residents. The new law was the product of months of research and deliberation initiated by the Nursing Home Safety Task Force appointed by Governor Quinn.

A key provision of Public Act 96-1372 requires Healthcare and Family Services (HFS) to implement drug prior approval requirements for LTC residents who are receiving psychotropic medications that may constitute a "chemical restraint" or an "unnecessary drug". In order to comply with this statutory provision, effective June 1, 2011, HFS will require prior authorization for all antipsychotic medications before they may be dispensed to LTC residents. HFS will mitigate the initial impact of the prior authorization requirements by grandfathering LTC residents who have a diagnosis of serious mental illness on their current antipsychotics.

HFS is providing this advance notice to allow long term care facilities and prescribing practitioners sufficient time to review patient medication regimens and request prior approval where appropriate. LTC medical directors will be expected to consult with ordering practitioners on the reviews of medication therapies, as well as to facilitate prior approval requests. HFS has developed Form HFS 168, a unique prior authorization request form for use when requesting prior authorization for antipsychotic medications for LTC residents. If a provider believes that a patient needs to remain on an anti-psychotic drug, it is important that the provider request prior authorization prior to June 1, 2011.

During non-business hours such as weekends, evenings, or holidays, pharmacies may dispense an emergency 72-hour supply of covered prescription drugs, and HFS will approve the limited drug quantities in these emergency situations. Pharmacies are required to subsequently submit prior approval requests that clearly document the need for the emergency 72-hour supplies.

As this initial HFS prior approval process progresses, HFS will review, and consult with appropriate medical professional organizations regarding possible additions of other drug classes. Most notably, HFS shall closely evaluate utilization patterns of Anxiolytic drugs, and may subsequently implement additional prior approval requirements in future months, if indicated.

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