Transcript District of Columbia Medical Assistance Administration

District of Columbia
Medical Assistance Administration
Expedited Prior Authorization
Pharmacy Guidance
NOTE: As of October 1, 2008, the Medical Assistance
Administration will become the
Department of Health Care Finance
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Topics
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Introduction
Scope & Objective of this training
Overview of DC MAA Prior Authorizations
Overview of Expedited PA process
DC ACS Call Center Information
Pharmacy Practice Pearls
Questions & Concerns
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Scope and Objective
• DC Medical Assistance Administration (MAA) Prior Authorizations
are in accordance with Federal Regulation 42 U.S.C. 1396r-8(g)(2)
• MAA reserves the right to monitor all participating entities to ensure
compliance with the policies and procedures as outlined in the PA
Guidance document.
• The MAA Prior Authorization Guidance will be posted on the DC
PBM Website at www.dcpbm.com
• The objective of this training is to clearly define the prior
authorization policy and the procedures for the Expedited PA’s
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Overview of DC MAA Prior Authorizations
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MAA has developed several prior authorization protocols for use
in the medication management program. They are:
Expedited Prior Authorization (E-PA)
These are for PAs that are generated by prescriptions from
emergency facilities and Urgent Care centers
Narcotic Prior Authorizations (N-PA)
These are PAs for Schedule II medications intended for long-term
use
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Medication Therapy Management Prior Authorization (MTMPA)
This category include the medication therapy management
protocols implemented by MAA in other programs including the
following:
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Overview of DC MAA Prior Authorizations
(Continued)
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Preferred Drug List (PDL)
Opioid narcotics and narcotic combinations
Anti-ulcer therapy
Injectables
Hepatitis C medications
Growth hormone therapy
Synagis
These and other ongoing PA programs provide access
to necessary medications in a manner that is compliant
with the medications’ FDA-approved use and/or with
national guidelines, evidence-based medicine, or
nationally recognized standards of therapy.
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Overview of Expedited Prior Authorization Process
The dispensing pharmacist may verbally request a one-time PA for a
Schedule II narcotic medication when a prescription is generated by:
 An emergency facility, such as a hospital emergency room
 Urgent care center.
This PA process is not intended for
(a) long-term use
(b) more than two Schedule II narcotic prescriptions presented at one
time
(c) for prescription quantities greater than a seven (7) day supply.
The DUR agent at the Pharmacy Call Center can authorize a one-time
PA for such emergency use without having to contact the prescribing
physician.
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DC MAA Call Center Information
• ACS will provide assistance to providers and recipients through the
ACS Pharmacy Call Center at 1-800-272-9679
• ACS will provide clinical prior authorizations through the ACS
Pharmacy Call Center at 1-800-273-4962
 The dispensing pharmacist can call the ACS Pharmacy Call Center at
1-800-273-4962 to request a one-time PA for such use when this
emergency criterion is met.
• Clinical /PDL PA request form can be faxed to the ACS Pharmacy Call
Center at 1-866-535-7622. The forms are available at
www.dcpbm.com.
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Pharmacy Practice Pearls
• An Expedited PA process is now available.
• Always call the ACS Call Center for
assistance.
• Please do not send DC Medicaid
recipients away without talking to the ACS
Call Center.
• Thank you for your continuing partnership.
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Questions & Concerns
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