Prescribed Drugs Provider Manual - Iowa Department of Human ...

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IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage117DateAugust 1, 2013f. Refill Too SoonThe claim will be denied if not enough time has elapsed for the memberto use 90% of the supply issued under previously paid claim for thatmedication. An override will be considered if:♦ There is a change in dose;♦ The previously issued supply has been lost, stolen or destroyed; or♦ The member is traveling and will not be able to pick up the next refillat the normal time.g. Step Therapy EditsCertain therapeutic drug classes are subject to step therapy edits asdesignated on the Preferred Drug List. Antipsychotics-Atypicals:Step 1: Preferred generic drugs. No PA required.Step 2: Preferred brand name drugs. No PA required if a preferredgeneric trial is found in the paid claims system in the past 12 months.Step 3: Non-preferred drugs. PA required.h. Tablet SplittingCertain medications that are scored and easily halved should be split tofacilitate more cost-effective use of the drugs.Drug Product Quantity Days’ Supply CommentsAbilify 2 mg 15 30Abilify 5 mg 15 30 Use 10 mg tablets toobtain 5 mg daily doseAbilify 10 mg 15 30 Use 20 mg tablets toobtain 10 mg daily doseAbilify 15 mg 15 30 Use 30 mg tablets toobtain 15 mg daily doseAbilify 20 mg 15 30Abilify 30 mg 15 30Lexapro 5 mg 15 30 Use 10 mg tablets toobtain 5 mg daily doseLexapro 10 mg 15 30 Use 20 mg tablets toobtain 10 mg daily dose
IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage118DateAugust 1, 2013i. Therapeutic DuplicationIf a second claim submitted is a therapeutic duplication of a drugalready submitted and reimbursed, overlapping claims will be consideredon an individual basis.Deny regardless of prescriberAnti-narcolepsy oranti-hyperkinesisagentsAntipsychoticsBarbituratesCentral nervoussystem stimulantsNonsteroidal antiinflammatorydrugs(NSAIDs)Provide prescriber verified documentation of thenecessity of the duplication in the treatment plan.After 12 weeks (84 days) of concomitant oral andinjectable antipsychotic medication use, provideprescriber verified documentation of the necessity inthe treatment plan.Provide prescriber verified documentation of thenecessity of the duplication in the treatment plan.Provide prescriber verified documentation of thenecessity of the duplication in the treatment plan.After 60 days of concomitant use, provide prescriberverified documentation of the necessity of theduplication in the treatment plan.9. Status Change for Preferred Brand Name DrugsWhen the status of a previously preferred brand-name drug changes tononpreferred, pharmacies are given a transition period of up to 30 days toallow utilization of existing stock of the brand-name product.If additional stock remains beyond this period, pharmacies may call the Pointof Sale (POS) Helpdesk at 877-463-7671 or 515-256-4608 (local) to requestan override for the nonpreferred brand-name drug with a recent statuschange.10. Travel or Vacation Supplies of MedicationRequests of medications for travel or vacation should be planned well inadvance of the departure date.The pharmacy can process the first month’s prescriptions as usual, and thenmay call the Point of Sale (POS) Helpdesk at 877-463-7671 or 515-256-4608(local) to obtain up to a one-month supply of medications to total up to a60-day supply of medication.
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