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

IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsPage1DateAugust 1, 2013TABLE OF CONTENTSPageCHAPTER III. PROVIDER-SPECIFIC POLICIES .................................................. 1A. GENERAL PHARMACY GUIDELINES ............................................................... 11. Definitions ......................................................................................... 12. Entities Involved in Developing Medicaid Drug Policies ............................. 5a. Drug Utilization Review Commission ............................................... 5b. Pharmaceutical and Therapeutics Committee ................................... 63. Pharmacies Eligible to Participate .......................................................... 7a. Licensure .................................................................................... 7b. Survey Participation ..................................................................... 74. Pharmacist Responsibilities................................................................... 8a. Prospective Drug Utilization Review ................................................ 8b. Dispensing Requirements .............................................................. 8c. Patient Counseling ....................................................................... 8d. Reason for Denial ........................................................................ 95. Drug Use Review ............................................................................... 10B. COVERAGE OF SERVICES ........................................................................... 111. Prescription Requirements ................................................................... 11a. Prescriber Qualifications .............................................................. 11b. Prescriber Guidelines ................................................................... 122. Drugs Excluded From Coverage ........................................................... 123. Drugs for Medicare Eligibles ................................................................ 134. Preferred or Recommended Drugs ........................................................ 135. Nonpreferred Drugs ........................................................................... 146. Newly Released Drugs ........................................................................ 14a. New Drug Entities ....................................................................... 14b. Exceptions to the Nonpreferred Default Policy for New PDL Drugs ...... 15c. Existing PDL Drugs With Supplemental Rebates .............................. 157. Nonprescription Drugs ........................................................................ 168. Medical Supplies ................................................................................ 18C. PRIOR AUTHORIZATION REQUIREMENTS ..................................................... 181. Completing a Prior Authorization Request .............................................. 212. Submitting a Prior Authorization Request .............................................. 233. Prior Authorization Response ............................................................... 244. ADD/ADHD/Narcolepsy Agents............................................................. 255. Alpha 2 Agonists, Extended-Release ....................................................... 26