Historical Remittance Advice Provider Alerts
2008
December 30, 2008
In accordance with the Settlement Agreement of Hernandez vs. Medows, which became effective May 24, 2004, Medicaid Pharmacies are required to post a notice and to provide information pamphlets to Medicaid recipients when payment for a prescription is denied. The notice and pamphlets will be provided to Pharmacies by the Agency for Health Care Administration at no cost.
For additional information contact Medicaid Pharmacy Services at (850) 412-4166.
April 25, 2008
Effective immediately, the southeast region will be extended beyond April 30, 2008 for Synagis. Some beneficiaries will receive automatic approval for the months of May 1, 2008 to September 30, 2008 based upon the beneficiaries zip codes, without resubmission of a prior authorization request. The most immediate extension will apply only to beneficiaries who are currently less than or equal to one year old. For those beneficiaries aged 13 to 23 months, compliance between the months of October 2007 and April 2008 will be reviewed. Those identified as "noncompliant" (with 3 doses or less) will be dropped from the prior authorization list. Providers will then need to resubmit a prior authorization request for those dropped. For those not dropped they will, also, receive automatic approval for an extension through September 30, 2008. The prior authorization process would then recycle beginning in October 1, 2008 and extend to April 30, 2009. Prior authorization forms will be developed for each individual region.
If you have questions or require assistance in submitting a prior authorization request, please contact the fiscal agent at 800-603-1714 or Medicaid Pharmacy Services at 850-412-4166.
April 9, 2008
Effective April 25th, 2008, Medicaid will require a prior authorization for atypical anti-psychotics for children under the age of six years. The prior authorization request form will be posted on the Agency for Health Care Administration (AHCA) website prior to April 25th, 2008. You may access the form on the AHCA website at: http://ahca.myflorida.com/Medicaid/Prescribed_Drug.
If you have questions or require assistance in submitting a prior authorization request, please contact the fiscal agent at 800-603-1714 or Medicaid Pharmacy Services at 850-412-4166.
April 1, 2008
Effective immediately, all current Medicaid Pharmacy prior authorization (PA) requests for Synagis (Palivizumab) will be extended through April 30, 2008. Recipients who have an existing prior authorization request for Synagis will be automatically approved for an additional dose without the resubmission of a PA form. This applies to all prescriptions written for Medicaid recipients.
Effective April 1, 2008 Soma (Carisoprodol) will be removed from the Preferred Drug List (PDL). Claims for all recipients will deny and require prior authorization. Recipients with requests for initiation of therapy must have failed two other PDL skeletal muscle relaxant agents. Approval will be limited to one month supply (120 tablets) during a 365 day period. Recipients currently on therapy will be allowed up to a one month supply to allow for tapering. Options for tapering include a four or nine day tapering protocol.
2007
April 2, 2007
Effective, May 1, 2007, the continuation of therapy lab criteria has changed for Procrit/Aranesp. Patients must have a hemoglobin level less than 12 gm/dl for continuation of therapy. When the hemoglobin is greater than 12 gm/dl, reduce the dose by 25% and continue therapy when the hemoglobin falls below 12 gm/dl. Prior authorization forms and criteria can be found on the website at, http://ahca.myflorida.com/Medicaid/Prescribed_Drug/pharm_thera/paforms.shtml.
March 30, 2007
Effective immediately, the Food and Drug Administration (FDA) has determined that the following drugs DESI Code indications be changed to DESI Code 5 (less than effective-drug withdrawn from market). These drugs will no longer be eligible for Medicaid reimbursement: Zolene, Zocort, Cortic, Tri-Otic, Otozone, Otirx, Cytotic, Otomar and Zoto otic preparations.
March 27, 2007
Florida Medicaid requires the reporting of the National Drug Code (NDC) on all claims with J, Q, or S drug codes received on and after January 7, 2007, regardless of the date of service. Please enter this information in Block 24 on the revised CMS-1500 claim form. Enter the identifier N4 immediately followed by the NDC code in the shaded area above 24-A. DO NOT leave a space or place a hyphen or other separator between the N4 identifier and the NDC code. For claims submitted in the 837 professional or institution, electronic claim format, loop 2410 LIN segment must contain the NDC number. Edit 241, NDC missing, will deny for Medicaid fee-for-service claims processed on and after April 1, 2007. For dually eligible Medicare/Medicaid recipients, claims will not deny for the NDC missing with edit 241 until June 1, 2007. Please contact your Medicaid area office if you need assistance.
February 20, 2007
Effective immediately claims for initial therapy with Triple nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) drug regimens require prior authorization for AIDS/HIV antiretroviral naïve recipients.
2002
April 9, 2002
In an effort to control drug diversion, the Medicaid office is implementing new requirements for the dispensing of drugs to recipients in Dade, Broward, Monroe, and Palm Beach counties. Effective April 15, 2002, all pharmacies in these counties shall be required to dispense drugs in accordance with one of the following three methodologies:
- Remove drugs from original manufacturer's packaging and place in pharmacy
vials.
- Inscribe "M" on the original manufacturers' packaging with an indelible
black marker. The "M" should be readily visible on the packaging and no less
than one inch in size.
- Remove manufacturers' seals from the original containers.
Thank you for your assistance and for your participation in the Medicaid program.
