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

IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage91DateAugust 1, 2013b. Reimbursement for FUL DrugsFor the drug groups on the Preferred Drug List where brand-nameproducts are preferred over generic products, the FUL rate will continueto apply when the generic version of the drug is dispensed.However, the payment for preferred brand name products (which nolonger require prior authorization before dispensing) equals the lower ofthe average acquisition cost (average AAC) or the submitted charges, asopposed to the FUL/SMAC rate.Nonpreferred brand products require prior authorization beforedispensing. If authorized, payment equals the lower of the the averageacquisition cost (average AAC) or the submitted charges, as opposed tothe FUL rate with a prior authorization. The DAW=1 is no longerrequired for brand reimbursement.Prior authorization is required for selected brand-name drugs asdetermined by the Department for which there is available, an “A” ratedbioequivalent generic product as determined by the federal Food andDrug Administration.For prior authorization to be considered, evidence of a treatment failurewith the bioequivalent generic drug must be provided. A copy of acompleted form 470-4119, Request for Prior Authorization: SelectedBrand Name Drugs, shall be considered as evidence of treatment failure.The list of selected brand-name drugs includes the drugs on the FederalUpper Limit (FUL) list at http://mslciowa.com/AAC.htm. Priorauthorization is not required for brand name drugs that have beendesignated by the Department as preferred (payable) under the IowaMedicaid Preferred Drug List (PDL).3. Reimbursement for Unit-Dose PackagingAdditional reimbursement of one cent per dose shall be added to theallowable ingredient cost of a prescription for an oral solid if the drug isdispensed to a patient in a nursing home in unit dose packaging prepared bythe pharmacist. Unit-dose reimbursements are permitted only for patientswith Plan 300 eligibility.