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

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IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage11DateAugust 1, 2013B. COVERAGE OF SERVICESPayment will be made for legend and nonprescription drugs when prescribed by apractitioner who is legally qualified to prescribe the item, subject to the limitationsdescribed in this manual.1. Prescription RequirementsPrescription records are required for all drugs as specified in Iowa pharmacyand drug laws, including Iowa Code sections 124.308, 155A.27, and 155A.29.For Medicaid purposes, prescriptions are required for nonprescription drugsand are subject to the same provisions. This includes the record-keepingrequirements on refills. Maintain prescriptions on file in such a manner thatthey will be readily available for audit by the Department.Prescriptions executed in writing (nonelectronic) for prescription drugs mustbe presented on a tamper-resistant pad, as required by Section 1903(i)(23)of the Social Security Act (42 U.S.C. Section 1396b(i)(23)).a. Prescriber QualificationsPayment is made for drugs prescribed by a legally qualified practitioner(physician, dentist, podiatrist, therapeutically certified optometrist,physician assistant, or advanced registered nurse practitioner) withinthe limits prescribed by law and in policies established by theDepartment.Prescriptions by a therapeutically certified optometrist are limited to thefollowing:♦ Topical and oral antimicrobial agents♦ Topical and oral antihistamines♦ Topical and oral antiglaucoma agents♦ Topical and oral analgesic agents, including controlled substances♦ Topical anesthetic agents♦ Topical anti-inflammatory agents
IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage12DateAugust 1, 2013b. Prescriber GuidelinesPrescribers should review the therapy of their Medicaid patients forutilization of nonpreferred drugs and wherever medically appropriate,change patients to preferred drugs. New therapy should be initiated ona preferred drug unless a nonpreferred drug is medically necessary.When a nonpreferred drug is medically necessary, the prescriber shouldrequest a prior authorization. See PRIOR AUTHORIZATIONREQUIREMENTS for information on criteria for prior authorization andprocedures.In writing prescriptions, the practitioner shall prescribe up to a 31-daysupply, unless therapeutically contraindicated. EXCEPTION: Oralcontraceptives may be prescribed in 90-day quantities.2. Drugs Excluded From CoverageMedicaid payment will not be made for:♦ Drugs used to cause anorexia, weight gain or weight loss.♦ Drugs used for cosmetic purposes or hair growth.♦ Drugs used for symptomatic relief of cough and colds, except fornonprescription drugs listed in section B.7.♦ Drugs used for fertility purposes or for male sexual enhancement.♦ Drugs prescribed for a use other than the drug’s medically accepted use.♦ Drugs classified as less than effective by the Centers for Medicare andMedicaid Services.♦ Drugs marketed by manufacturers that have not signed a Medicaid rebateagreement.♦ Covered outpatient drugs for which the manufacturer seeks to require asa condition of sale that associated tests or monitoring services bepurchased exclusively from the manufacturer or designee.
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