Prescribed Drugs Provider Manual - Iowa Department of Human ...
Prescribed Drugs Provider Manual - Iowa Department of Human ...
Prescribed Drugs Provider Manual - Iowa Department of Human ...
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<strong>Iowa</strong><strong>Department</strong><strong>of</strong> <strong>Human</strong>Services<strong>Provider</strong> and Chapter<strong>Prescribed</strong> <strong>Drugs</strong>Chapter III. <strong>Provider</strong>-Specific PoliciesPage111DateAugust 1, 20138. Prospective Drug Utilization Review (Pro-DUR)The goal <strong>of</strong> Prospective DUR is to identify potential drug therapy concerns toallow the pharmacist to use pr<strong>of</strong>essional judgment regarding the need forintervention, such as whether or not to contact the prescribing physician.The following prospective DUR edits will cause claims to deny:EditNumber andMessageReason for the Denial* OverrideProvidedAge Edits75 - PRIORAUTHORIZATIONREQUIREDCertain medications arepayable only for specificage groups.PA required.CostEffectiveness75 - PRIORAUTHORIZATIONREQUIREDCertain strengths shouldbe substituted withmore cost-effectivestrengths <strong>of</strong> the samemedication.PA required.DosageForm75 - PRIORAUTHORIZATIONREQUIREDAdditional text:NONPREFERREDCertain dosage formsshould be substitutedwith more cost-effectivedosage forms <strong>of</strong> thesame medication.PA required.ExcessiveDaysSupply19 - M/I DAYSSUPPLYAdditional text:EXCEEDS ALLOWABLEDAYS SUPPLYThe supply submitted ismore than 31 days.Request anexception topolicy if there is avalid reason whya supply morethan 31 days isrequired.15-DayInitialPrescriptionSupplyLimit76 - PLAN LIMITSEXCEEDEDThe supply submitted ismore than 15 days onselect drugs.PA required. SeeQuantity LimitOverride.