November 2016

72-hour Emergency Prescription Supply

A 72-hour emergency supply of a prescribed drug must be provided when a medication is needed without delay and prior authorization (PA) is not available. This applies to all drugs requiring PA, either because they are non-preferred drugs on the Preferred Drug List (PDL) or because they are subject to clinical edits.

The 72-hour emergency supply should be dispensed any time a PA cannot be resolved within 24 hours for a medication on the Vendor Drug Program formulary that is appropriate for the member’s medical condition. If the prescribing provider cannot be reached or is unable to request a PA, the pharmacy should submit an emergency 72- hour prescription.

The PDL is available online at www.txvendordrug.com.

A pharmacy can dispense a product that is packaged in a dosage form that is fixed and unbreakable (e.g., an albuterol inhaler), as a 72-hour emergency supply.

To be reimbursed for a 72-hour emergency prescription supply, pharmacies may enter an “8” in field 461-EU (Prior Authorization Type Code) and code 801 in field 462-EV (Prior Auth Number Submitted) to override a 75/PA required rejection and submit a claim for a 72-hour emergency supply.

Providers may call the Prime® Help Desk for more information about the 72-hour emergency prescription supply policy at:

STAR: 855-457-0405
CHIP: 855-457-0403