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PHARMACY UPDATE - Emergency Declaration: COVID-19 Medication Access Updates
4/13/2020 • Posted by Provider Relations

Pharmacy Medication Guidance

  • 90-day Supplies:
  • Medicaid covers a 90-day supply for most prescription and over the counter (OTC) maintenance medications
             Please note, prior authorization may be required for 90-day supplies of some medications.
  • Where practicable, practitioners and pharmacists may utilize 90-day supplies of long-term maintenance medications for individuals in quarantine or those that have been identified by the CDC as being at a higher risk for developing serious illness from COVID-19.
     
  • Medication Delivery:
    • Pharmacies that choose to provide delivery to individuals quarantined may confirm receipt of the medications by the member through a phone call, text or email, in lieu of getting a signature.
       
  • Prescription transfers:
    • If a Medicaid member has had a prescription filled from a pharmacy that is inaccessible or to that pharmacy is not feasible, then he/she can obtain a new prescription/fiscal traveling order from the prescriber; OR
    • A refill of the prescription can be transferred to another Medicaid participating pharmacy (where allowed by law).

For Retail Pharmacies: Refill Too Soon Rejection Overrides

“Refill Too Soon” edits are available for pharmacies to utilize in order to provide early refills to members in response to emergencies.

Pharmacy Claim Submission Information

When a claim submission results in a “refill too soon” rejection, pharmacies may enter the following information to re-process the claim:

Field #

NCPDP Segment & Field Name

Required Emergency Information for Processing

 

420-DK

 

Submission Clarification Code

13

325-CP

Patient Zip/Postal Zone

The zip/postal code of patient’s address

Covered Lines of Business

  • Medicaid (Medicaid Managed Care, Child Health Plus, and HealthierLife)
  • Essential Plan
  • Health Benefit Exchange (Metal Level Products)
  • Medicare Part D

Contact Numbers

  • CVS Help Desk, Medicaid and Commercial Plans: 1-800-364-6331
  • CVS Help Desk, Medicare Part D: 1-866-693-4620
  • Fidelis Care Help Desk: 1-888-FIDELIS

Authorization Resources

To submit prior authorization request types, use the Fidelis Care provider portal.

Electronic Transactions

Submit claims electronically with Fidelis Care.

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Important Information on Coverage Decisions

Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on many health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward providers or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff based on decisions that promote underutilization of services. 

Fidelis Care is committed to ensuring that members have the care and services they need. 

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Submit Authorization Requests

Utilization management systems available to submit authorization requests.