January 10, 2014

State of Alabama
Press Release: Medicaid

UPDATE TO MONTHLY PRESCRIPTION LIMIT Effective January 1, 2014

TO:  Pharmacies, Physicians, Physician Assistants, Nurse Practitioners, Oral Surgeons, Optometrists, Dentists, FQHCs, RHCs, Mental Health Service Providers, Hospitals and Nursing Homes

Effective January 1, 2014, the Alabama Medicaid Agency will:

1.              Limit the number of outpatient pharmacy prescriptions to five total drugs (including up to four brands) per month for adults. Children under 21 and nursing home recipients are excluded. Prescriptions will be tracked by the claims processing system, and up to five additional brand and generic antipsychotics, antiretrovirals, and anti-epileptic drugs will be automatically approved up to the 10 (total) prescription limit.  Prescriptions for the three month maintenance supply will not count toward the monthly prescription limit. Due to this exclusion:

 

·         Maintenance supply medications dispensed between 1/1/14 and 1/9/14 must be reversed and retroactively rebilled to be excluded from the prescription limit.

 

·         Claims denied between 1/1/14 and 1/9/14 as a result of the prescription limit may now be eligible for coverage, and can be resubmitted.

 

·         Maintenance medications dispensed on or after 1/10/14 will be excluded from the prescription limit. No further action will be needed for these claims.

 

2.            Implement a mandatory three month maintenance supply program for selected medication classes. A maintenance supply prescription will be required after 60 days stable therapy. The selected classes can be found on the Alabama Medicaid website.

 

Policy questions concerning this provider notice should be directed to the Pharmacy Program at (334) 242-5050. Questions regarding prior authorization procedures should be directed to the HID help desk at 1-800-748-0130.

 



  • For more information, visit http://medicaid.alabama.gov
  • For more state-wide press releases, click here