LDH: Tropical Storm Barry Information for Medicaid Pharmacy
Date: 07/12/19
On July 10 2019, Governor John Bel Edwards declared a state of emergency for Tropical Storm Barry which is expected to make landfall along the gulf coast on Saturday, July 13, 2019. As a result of the gubernatorial emergency declaration, the required emergency measures should be taken for pharmacy services in the following parishes [as of July 13, 5:30 pm]:
- Jefferson
- Plaquemines
- St. Mary
- Terrebonne
Additional parishes that may be added in the future.
Pharmacists Authority to Dispense Prescriptions in an Emergency
The Louisiana Board of Pharmacy reminded pharmacists about Section 519 of the Board's rules, titled State of Emergency that has been activated and is now in effect. This rule is automatically activated whenever the Governor of Louisiana declares and/or renews a state of emergency for some or all of the parishes of Louisiana.
The rule states, in part:
"1. A pharmacist may work in the affected parish(es) and may dispense a one-time emergency prescription of up to a thirty day supply of a prescribed medication if: ( a) in the pharmacist's professional opinion the medication is essential to the maintenance of life or to the continuation of therapy, and (b) the pharmacist makes a good faith effort to reduce the information to a written prescription marked "Emergency Prescription", then file and maintain the prescription as required by law."
The above is noted to instruct pharmacists of prescription regulations during a time of emergency. This applies to all patients, regardless of whether they have public or private health insurance coverage or are uninsured. Reimbursement for the prescription is not addressed by this regulation.
Procedures for Emergency Prescriptions Claims for Medicaid Recipients
Fee for Service (FFS) and the managed care organizations (MCOs) have the following instructions per plan to process necessary prescription overrides:
[Note: LDH provided updated information for the chart below on July 12, 2019, 4:15 pm]
| Plan/Pharmacy Help Desk Numbers | Early Refill/Refill too soon | Prior Authorization |
|---|---|---|
Aetna | Bypass | Bypass except for controlled and specialty drugs |
| Healthy Blue (833) 236 6194 | Allow pharmacist to override by entering SCC Code 13 in NCPDP field 420-DK (Submission Clarification Code) | Emergency Fill Claim Submission INformation except for controlled and specialty drugs Field Name: Days Supply Field Name: Prior Auth Type Code Field Name: Prior Auth NUmber Submitted |
| AmeriHealth Caritas (800) 684-5502 | Bypass | Bypass except for controlled and specialty drugs |
| Louisiana Healthcare Connections (888) 929-3790 | Allow pharmacist override by entering a Submission Clarification Code of "13" (except controlled and specialty drugs) | Allow pharmacist override by entering a Submission Clarification Code of "13" (except controlled and specialty drugs) |
| United HealthCare (866) 328-3108 | Allow pharmacist override by entering a Submission Clarification Code of "13" | Allow pharmacist override by entering a Submission Clarification Code of "13" (except controlled and specialty drugs) |
| Fee for Service (800) 437-9101 | Pharmacist override utilizing the codes below:
ID: Ingredient Duplication (for different pharmacy) ER: Overuse/Early Refill (for same pharmacy)
MO: Prescriber Consulted PO: Patient Consulted RO: Pharmacist Consulted other source
lA: Filled as is, False positive
| Bypass except for controlled and specialty drugs |
The MCO and FFS procedures are limited to recipients residing in the following parishes: Jefferson and Plaquemines.
Eligibility and Drug Utilization Data for Medicaid Recipients
Pharmacists may access the Louisiana Medicaid website at www.lamedicaid.com. This website is a useful tool to access information regarding recipients, prescribing provider numbers and clinical data. To gain access to the website, providers should follow directions on the website. Providers should obtain a log-in ID and password. Detailed instructions are at www.lamedicaid.com, then "Provider web account registration instructions" or at this link:
https://www.lamedicaid.com/provweb1/Provweb_Enroll/Web_Registration.pdf
- Providers are able to access the Medicaid Eligibility Verification System (MEVS) to verify recipient eligibility. Go to Provider Log-In on www.lamedicaid.com., enter Medicaid ID or NPI then enter Log-In ID and password. Go to Medicaid Eligibility Verification System, and then enter the recipient's name and date of birth or social security number.
- Proyiders may access recipient pharmacy claim history for both FFS and MCOs through the electronic Clinical Data Inquiry (e-CDI). Go to Provider Log-In on www.lamedicaid.com, enter Medicaid ID or NPI then enter Log-In ID and password. Go to Electronic CLinical Data Inquiry, enter recipient ID and date of birth, find recipient, then clinical drug inquiry.
Pharmacy providers may contact the ULM Prior Authorization Call Center (866) 730-4357 for assistance with recipient drug history. The call center is open Monday-Saturday 8am-6pm. The following information would be appreciated:
- Name;
- Date of birth;
- Recipient identification number, and/or social security number.
Your continued cooperation and support of the Louisiana Medicaid Program efforts to coordinate care and improve health are greatly appreciated.
View the original PDF of this LDH Provider Notice (PDF).