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TO: Pharmacies, Physicians, Physician Assistants, Nurse Practitioners, Oral Surgeons, Optometrists, Dentists, FQHCs, RHCs, Mental Health Service Providers, and Nursing Homes
The Alabama
Medicaid Agency is closely monitoring the Coronavirus Disease 2019 (COVID-19). In
response, the below accommodations related to pharmacy claims will be in
place for 30 days, at which time the Agency will reassess and notify our
provider community.
1.
Early Refill (ER) Edits: A universal PA number may be used
when claims deny for ER. This universal override number will apply to all
medications that hit the ER edit. The pharmacist should use clinical judgement
when determining if the universal PA number is utilized.
a. The universal PA number will be: 9999999999.
b. This change is anticipated to be effective by Wednesday, March 25th,
or earlier.
2. Morphine Milligram Equivalent (MME): The Agency will postpone
the implementation of the cumulative daily MME edit decrease scheduled for
April 1, 2020. Please refer to the previous ALERT here for
more information. Current MME
limitations will remain in place.
3. 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
Agency website under Pharmacy/Programs/Preferred Drug List. Pharmacists are
encouraged to report drug shortages to the Agency, or the contractor Myers
& Stauffer, if they occur. Myers & Stauffer may be reached by clicking here.
4. Maintenance Supply Program: The Alabama Board of Pharmacy (ALBOP) has implemented emergency refills for maintenance
medications (see guidance here).
In conjunction with the ALBOP’s guidance, Alabama Medicaid will allow overrides
for maintenance supply medications. This allowance will go into effect
immediately. The Medicaid override form can be found at: https://medicaid.alabama.gov/documents/9.0_Resources/9.4_Forms_Library/
9.4.14_PA_Forms/9.4.1.4_PH_PA_Form_409_Override_Fillable_7-2-18.pdf
5. Prior Authorization (PA) Requirements:
Medicaid will allow for temporary
exceptions for prior authorization renewal
requests for lab values or urine drug screens that require an in-person visit
with a lab or provider. This allowance will go into effect immediately and will
apply to renewal requests.
Alabama Medicaid will continue to review policies and
procedures as needed to ensure the safety of the public. Policy questions
concerning this provider notice should be directed to the Pharmacy
Program at (334) 242-5050. Questions regarding PA procedures should be directed
to the HID help desk at
1-800-748-0130.