Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 214 - Pharmacy Services
Chapter 1 - General Pharmacy
Rule 23-214-1.4 - Prior Authorization
Universal Citation: MS Code of Rules 23-214-1.4
Current through September 24, 2024
A. The Division of Medicaid requires prior authorization of certain covered drugs to ensure use as approved by the Food and Drug Administration (FDA) for specific medical conditions.
1. Prior authorization of drugs
must be obtained from the Division of Medicaid's Pharmacy Prior Authorization
Unit or its designee before the drug may be dispensed.
2. All prior authorization requests must be
submitted electronically via web-portal or by facsimile.
3. Only the Mississippi Medicaid enrolled
prescribing provider or a member of the provider's staff may request prior
authorization.
4. Prior
authorization requests submitted by agents of drug manufacturers will be
denied.
B. The Division of Medicaid reimburses for a seventy-two (72) hour emergency supply of a prescribed drug when a medication is needed without delay and prior authorization is not available and applies to all drugs requiring a prior authorization either because they are:
1.
Non-preferred drugs listed in the Preferred Drug List (PDL), or
2. A drug affected by clinical or prior
authorization edits which would need prescriber prior approval.
42 USC § 1396r - 8(d)(5); Miss. Code Ann. §§ 43-13-117(A)(9), 43-13-121, 73-21-129.
Disclaimer: These regulations may not be the most recent version. Mississippi may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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