Ohio Department of Job and Family Services Provides Information Regarding Changes to Coverage of Prescription Drugs for Members of MCPs |
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Beginning with date of service February 1, 2010,
prescription drug coverage for members of Medicaid MCPs will transfer to the
Medicaid fee-for-service (FFS) program. This change means that all Medicaid
consumers will have the same list of covered drugs and same prior
authorization policy. Medicaid MCPs are no longer responsible for
prescription drug coverage for their members. This change is only for
prescription drugs that are administered in the patient's home, not for any
drugs that are administered in a provider setting such as physician office,
hospital outpatient department, clinic, dialysis center, or infusion center.
Drugs administered in a home health setting should be billed through the
fee-for-service pharmacy program. Some medical supplies, such as diabetic
testing supplies, supplies for injection of insulin and other drugs, inhaler
spacers, and peak flow meters, will only be able to be billed by pharmacies
(including hospital pharmacies) and will no longer be covered when billed by
any other provider type, including durable medical equipment (DME) dealers,
clinics, or individual physician offices. ODJFS also has issued information
about CyberAccess, a secure web site that allows Ohio Medicaid providers to
review the Medicaid prescription claims history for their patients, review
prescription prior authorizations, and send electronic prescriptions (eprescribe)
for their Medicaid patients. Prescriptions billed through the FFS program
may be subject to co-payments. In addition, the federal requirement for
tamper-resistant prescription pads will now include prescriptions for
members of MCPs because they will be billed to the FFS program. Each of
these topics is explained in more detail in a letter issued by the ODJFS. To
view the letter go to: |
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