Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 29 - Division of Medical Services › Rule 016.29.22-011 - Pharmacy (1-22) Provider Manual change for combining the DUR Board and DRC

Current through Register Vol. 49, No. 6, June, 2024
240.000
PRIOR
			 AUTHORIZATION
Prescription drugs may be reimbursed under the Arkansas
				Medicaid Program pursuant to an order from an authorized prescriber.
The prescriber must initiate the prior authorization (PA) for
				prescription drugs that require PA. The PA request must be completed and
				submitted by the prescriber. All PA documentation must remain in the patient's
				chart and will be subject to audit by the Division of Medical Services or its
				authorized representatives.
In addition, clinical edits will be established through a
				system modification enhancement, as well as limits placed on drugs based on
				age, gender, quantity, and dosage, as approved by our Drug Utilization Review
				Board. Lists of all drugs, subject to clinical editing and the criteria for
				reimbursement, are maintained by DHS or its contracted Pharmacy Vendor. View or
				print the
DHS Contracted Pharmacy Vendor Help Desk contact
				information.
Arkansas Medicaid Pharmacy Program will maintain a Preferred
				Drug List based on comparative evidence-based data from Clinical Evidence
				Reports (CER). Arkansas Medicaid Pharmacy Program will use the CER to identify
				drug class or drug classes of medications that have similar indications,
				efficacy, and safety. Arkansas Medicaid will negotiate state supplemental
				rebates with manufacturers for the identified medication(s), pursuant to a CMS
				approved State Supplemental Rebate Agreement. A Drug Cost Committee (DCC) will
				review both State Supplemental and Federal rebates to determine the final net
				cost to the State. The Drug Utilization Review (DUR) Board will review the CER
				to determine safety and efficacy of the identified medication(s). The DCC and
				DUR Board will provide recommendations to the State for preferred and
				non-preferred status for the identified medication(s). Arkansas Medicaid will
				use these recommendations to establish and maintain a Preferred Drug
				List.
In an emergency, for those drugs for which a five-day supply
				can be dispensed, an Arkansas Medicaid enrolled pharmacy may dispense up to a
				five-day supply of a drug that requires prior authorization. This provision
				applies only in an
emergency
situation when the DHS Contracted
				Pharmacy Vendor Help Desk and the State Medicaid Pharmacy Program offices are
				closed, and the pharmacist is not able to contact the prescribing provider to
				change the prescription. The Emergency Supply Policy does not apply to drugs
				that are not covered by the State. Frequency of the emergency override is
				limited to one (1) time per year per drug class for non-LTC beneficiaries and
				one (1) time per sixty (60) days per drug class for LTC beneficiaries. To file
				a claim using this emergency provision, the pharmacy provider will submit a
				"03" in the Level of Service (418-DI) field.
Prior Authorization information is maintained by DHS or its
				contracted Pharmacy Vendor.
View or print the DHS Contracted Pharmacy
				Vendor Help Desk contact information.
The following information is available:
A. Prescription Drug Clinical Edits
B. Prescription Drug Claim Edits
C. Prescription Drug PA Forms
D. VRS System Brochure, and
E. Evidence-Based Prescription Drug
			 Program.