Any preferred drug list program implemented by the department must include:
(1) procedures to ensure that a request for prior authorization that has no material defect or impropriety can be processed within twenty-four hours of receipt;
(2) procedures to allow the prescribing physician to request and receive notice of any delays or negative decision in regard to a prior authorization;
(3) procedures to allow the prescribing physician to request and receive a second review of any denial of a prior authorization request; and
(4) procedures to allow a pharmacist to dispense an emergency, seventy-two hour supply of a drug requiring prior authorization without prior authorization if the pharmacist:
(a) has made a reasonable attempt to contact the physician and request that the prescribing physician secure prior authorization; and
(b) reasonably believes that refusing to dispense a seventy-two-hour supply would unduly burden the Medicaid recipient and produce undesirable health consequences.
HISTORY: 2008 Act No. 353, Section 2, Pt 4.C.1, eff July 1, 2008.
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