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Elizabeth M. Whitehorn, Director

Provider Notice issued 07/22/13

Handbook for Providers of Pharmacy Services – Availability on the Internet

To:​  Participating Pharmacies ​
Date:​ July, 22, 2013​
Re:​ Handbook for Providers of Pharmacy Services – Availability on the Internet​

Effective immediately, the department will begin allowing pharmacists to submit Four Prescription Policy prior approval requests (PA).  Prescribers will continue to be able to submit requests as well. 

Medication Regimen Review

Prior to submitting a PA request, the pharmacists should conduct a review of a patient’s complete medication regimen, consult with the prescribers regarding any concerns, and request a Four Prescription Policy PA for all drugs that the patient should continue.  In cases where patients are receiving inappropriate therapy, the pharmacist must include in the PA request:  1) a summary of the communication to the prescriber alerting the prescriber of the therapeutic duplication and the date of notification, 2) a summary of the prescriber’s response including their clinical justification for the prescribing, and 3) a plan for altering the medication therapy if the change is being made over an extended period of time to allow for titration.  Inappropriate therapy may include, but is not limited to, off-label use of a drug where there is no literature to support its use for the condition being treated; duplicate therapy, meaning more than one medication that has the same therapeutic effect to treat the same condition; or doses that exceed a product’s labeled dosing limitations.    

Submission Requirements for Prior Approval Requests

Pharmacists will be required to enter prior approval requests using the Medical Electronic Data Interchange (MEDI) System. To simplify the prior authorization request process, the department has added the Four Prescription Policy Override Request Form to the MEDI system. Requests entered into the MEDI system go directly into the department's drug prior approval adjudication database for review by a physician or pharmacist. Requests that are faxed to the department's Prior Approval Hotline must be data entered after receipt. Prior approval requests are typically reviewed within two hours of being entered into the adjudication database, but can take longer. The MEDI system also allows requestors to easily check the status of a prior approval request that was entered through the MEDI system, by using the prior authorization number that was assigned when the request was entered. More information about registering for MEDI, and requesting prior approval through the MEDI system, is available on the department’s MEDI website.

Certain drugs do not require prior approval due to the Four Prescription Policy and pharmacists should not request prior approval for those drugs. Drugs that do not require prior approval are listed on our Four Prescription Policy Web page.

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