Current through September 24, 2024
A. A written,
faxed, e-prescribed, or telephoned prescription may be refilled, in compliance
with the prescriber's order, up to a limit of eleven (11) times per year, if
compliant with state and/or federal regulations and guidelines. Additionally,
the following are applicable:
1. The absence
of an indication to refill by the prescribing provider renders the prescription
non-refillable.
2. Refills are
reimbursable only if specifically authorized by the prescribing provider.
3. The Division of Medicaid does
not reimburse prescription refills:
a)
Exceeding the specific number authorized by the prescribing provider.
b) Dispensed after one (1) year
from the date of the original prescription.
c) With greater frequency than the
approximate interval of time that the dosage regimen of the prescription would
indicate, unless extenuating circumstances are documented which would justify
the shorter interval of time before the refilling of the prescription.
d) With quantities in excess of
the prescribing provider's authorization.
e) Without an explicit request from a
beneficiary or the beneficiary's responsible party, such as a caregiver, for
each filling event. The possession, by a provider, of a prescription with
remaining refills authorized does not in itself constitute a request to refill
the prescription.
f) Until
seventy-five percent (75%) of the day's supply of the non-controlled substance
has elapsed as indicated on the prescription.
g) For any controlled substance (Schedule
III, IV, and V) until eighty-five percent (85%) of the day's supply of the drug
has elapsed as indicated on the prescription. Any attempt to refill a
prescription through the Point-of-Sale system before the twenty-sixth (26th)
day will be automatically denied.
h) For Schedule II controlled substances.
B.
Beneficiaries or providers cannot waive the explicit refill request and enroll
beneficiaries in an electronic automatic refill in pharmacies.
C. The Division of Medicaid allows pharmacy
providers to make prescription refill reminders including, but not limited to,
person-to-person phone calls, e-mail messages, and text messages when the
pharmacy provider:
1. Obtains written
authorization from the beneficiary or the beneficiary's responsible party to
receive prescription refill reminders,
2. Informs the beneficiary or the
beneficiary's responsible party of their freedom of choice of pharmacy
providers with each prescription refill reminder,
3. Offers the beneficiary or the
beneficiary's responsible party the opportunity to choose whether or not to
proceed with each prescription refill, and
4. Documents the following:
a) Date and time of each prescription refill
reminder,
b) Pharmacy provider
staff that initiated the prescription refill reminder,
c) Name of the beneficiary or the
beneficiary's responsible party that authorized the prescription refill, and
d) The beneficiary or the
beneficiary's responsible party was given freedom of choice of pharmacy
providers and the opportunity to choose whether or not to proceed with the
prescription refill(s).
D. The Division of Medicaid does not:
1. Reimburse pharmacy providers for
prescription refill reminders, or
2. Allow automated prescription refill
reminders including, but not limited to, robocalls or pre-recorded messages.
E. The Division of
Medicaid may permit an early refill of an original claim as long as the monthly
service limits have not been exhausted under one (1) of the following
circumstances:
1. The beneficiary's life is
at risk,
2. When an acute clinical
condition is occurring, which would require extra medication to stop or
mitigate further morbidity, or
3.
The prescribing provider either increases the dosing frequency or the amount
per dose.
a) The prescribing provider must
document the change in dosage or frequency by writing or calling in a new
prescription.
b) The prescriber(s)
who wrote the original prescription or the pharmacist filling the new order may
request for an early refill authorization.
4. If a beneficiary requires an early refill,
the prescribing provider must request an exception override of this requirement
by seeking approval from Division of Medicaid's Pharmacy Prior Authorization
(PA) Unit.
F. The
Division of Medicaid does not reimburse for replacement of prescription
medications unless the beneficiary can show good cause, which must include
documentation such as a police report or insurance claim, that the prescription
medications were lost, stolen or otherwise destroyed beyond the beneficiary's
control. A replacement may be approved only if the monthly service limit, if
applicable, has not been exhausted.
Miss. Code Ann. §
43-13-121.
