Date: March 30, 2020
To: All Participating Pharmacies
Re: Pharmacy - Temporary COVID-19 Billing Policies
In order to reduce participant visits to the pharmacy, promote social distancing, reduce barriers to participant access to medications, and ease the burden on pharmacies and prescribers due to COVID-19, the following temporary policy adjustments have been made.
Refill Too Soon-
Along with encouraging providers to use the medicine synchronization that HFS began allowing in early August 2019, HFS has also reduced the RTS tolerances on all medications.
Pharmacies can submit a Submission Clarification Code (420-DK) of 13, Payer-Recognized Emergency/Disaster Assistance Request, to override rejecting claims for RTS. Pharmacists should use clinical judgement to determine when it is appropriate to override the claim.
HFS has adjusted the days’ supply edit on insulin to allow for a 90 day supply to be filled and is reviewing potential additions to the 90-day supply list of maintenance medications.
Preferred Drug List (PDL)-
The Agency may need to make changes to the preferred drug list as a result of potential drug shortages. Non-preferred products may become preferred if shortages of preferred agents occur. Updates/changes will be maintained on the Department’s website on the PDL webpage.
Currently, all albuterol HFA inhalers and levalbuterol inhalers as well as generic levalbuterol nebulizer solutions have been changed to preferred.
Quantity for supplies-
Test strips quantity has been increased to a maximum of 300.
Lancets quantity has been increased to a maximum of 400.
Providers are reminded to bill an accurate day supply even if it exceeds one month.
Ordering, Referring, and Prescribing provider edits-
The edit requiring prescribing practitioners to be enrolled Medicaid providers has been temporarily turned off and will be reinstituted after the pandemic has ended.
The Department has instituted temporary coverage for acetaminophen and cough suppressants containing guaifenesin, dextromethorphan or their combinations.
3 Brand Limit-
Edits due to the participant receiving three brand name drugs during a 30 day period have been temporarily lifted.
4 Prescription Policy-
Edits due to the participant receiving more than four prescriptions during a 30 day period have been temporarily lifted.
The Department is currently waiving the signature requirements for receipt of prescriptions.
While the participant’s primary insurance should still be billed, claims will no longer be subject to prior approval in situations where the primary does not pay due to a rejection or deductible requirement.
Again, these changes are only temporary to control issues that arise with our participant population due to the outbreak of COVID-19. Other potential changes may be implemented at the Administration’s directive.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.
Interim Medicaid Administrator