Opinion ID: 2784541
Heading Depth: 3
Heading Rank: 2

Heading: cao 637-8

Text: This corrective action order begins by referencing ¶¶ 3, 129, and 130 of the Decree. It then describes Plaintiffs’ main complaint with pharmacists’ understanding of EPSDT’s prescription drug program: When EPSDT recipients seek to fill prescriptions for drugs that are not listed on the Program’s Preferred Drug List (“PDL”), pharmacists may fill them only if they have “prior authorization” from the prescribing physicians. If a prescribing physician does not provide the authorization or could not be reached, the pharmacist must dispense a 72-hour emergency supply so that the class member is not deprived of needed medication. Many pharmacists, however, did not know that the stopgap measure was available or treated it as optional and improperly withheld class members’ prescriptions. To remedy the pharmacists’ misunderstanding, CAO 637-8 established a detailed series of action items, elaborating on and expanding the requirements found in ¶¶ 124–30 of the Decree. CAO 637-8 is divided into 12 bullet points, of which 9 require specific actions by Defendants. Particularly contested in this appeal are their obligations in bullet points 6 and 10. 15 14 In March 2012, the EPSDT prescription drug program was transferred from direct state control to the control of managed care organizations. All Texas EPSDT recipients are now served by managed care organizations. 15 CAO 637-8 also requires Defendants to (1) change the Program’s electronic prescription processing system so that it reminds pharmacists of the 72-hour emergency policy; (2) “work with the Texas Pharmacy Association to explain” the policy; (3) make available a PDL database service that doctors may use online or download to a handheld device for reference while providing care; (4) “begin encouraging all Medicaid-enrolled 5 Case: 14-40048 Document: 00512959210 Page: 6 Date Filed: 03/05/2015 No. 14-40048 Bullet point 6 required Defendants to “provide intensive, targeted educational efforts to those pharmacies for which the data suggests a lack of knowledge of the 72-hour emergency prescriptions policy.” 16 In addition to these “intensive, targeted” efforts for particular noncompliant pharmacies, Defendants were also to “continue . . . educational efforts with respect to all Medicaid pharmacies.” Bullet point 10 required Defendants to train staff at their ombudsman’s office “about the emergency prescription standards,” including “what steps to take to immediately address class members’ problems when pharmacies do not provide emergency medicines.”