Agencies
Services
Provider Notice issued 09/09/14
Chapter P-200, Handbook for Providers of Pharmacy Services Four Prescription Policy Exception - Antipsychotics
| To: | Enrolled Pharmacies |
| Date: | September 9, 2014 |
| Re: | Chapter P-200, Handbook for Providers of Pharmacy Services Four Prescription Policy Exception - Antipsychotics |
This notice provides information regarding a change to the Four Prescription Policy related to antipsychotic drugs. In accordance with Public Act 98-0651, effective 7/1/14, antipsychotic drugs do not require prior approval under the Four Prescription Policy, even in cases where the participant has already filled four or more prescriptions in the preceding 30 days. Providers should not request a Four Prescription Policy override for those drugs. As a reminder, the classes of drugs that do not require prior authorization for the Four Prescription Policy are: Oncolytics, Anti-Retroviral Agents, Contraceptives, Anti-Convulsants, Immunosuppressives, Over-the-counter Drugs, and Antipsychotics.
In addition, non drug items, such as blood glucose monitors and test strips, are not subject to the Four Prescription Policy.
Simplified Process for Requesting Prior Approval
The department allows providers to request prior approval through the MEDI system. To simplify the prior authorization request process, the department has added the Four Prescription Policy Override Request Form to the MEDI system. Additional information is available at the Medi Prior Approval Request Provider Notice (pdf). Using MEDI is the fastest, easiest way to submit and monitor prior approval requests.
In addition, for prescribers who do not have access to the MEDI system, the department has created online applications to both submit and check the status of requests. The links for those applications are listed below.
You can also complete the following form and fax it to 217-524-7264, or call 1-800-252-8942 and provide all information requested on the Four Prescription Prior Authorization Request Form (pdf).
Emergency Situations
During non-business hours such as evenings and weekends, when department staff are not available to make a determination on a four prescription policy override prior authorization request, the pharmacy can dispense, and the department will pay for, an emergency 72-hour supply of a covered prescription drug to an eligible client in an emergency situation. The pharmacy is responsible for following up with a prior approval request for the emergency supply.
The Handbook for Providers of Pharmacy Services (pdf) has been updated and is available on the department’s Web site. Any questions regarding this bulletin should be directed to your facility’s medical assistance consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565, Option 7.
Instructions for updating the Handbook for Providers of Pharmacy Services:
P-204.13 Four Prescription Policy - Remove page HFS P-204 (7) and insert new page HFS P-204(7).