An emergency 72 hour supply for medications needed without delay and when prior authorization (PA) is not available, can be dispensed for non-mental health medications. For mental health medications, a 5 day (120 hour) supply may be given when medications are needed without delay and prior authorization (PA) is not available.
The rule applies to non-preferred drugs listed on the PDL-Preferred Drug List on the Preferred Drug List (PDL) page of this website and any drug that is affected by clinical or drug use limitation edits and would need prescriber prior approval. The emergency dispensing procedure should not be used for routine and continuous overrides.
In order to receive payment consideration for emergency dispensing of a PA medication, the pharmacy should:
Verify beneficiary eligibility and plan participation
Initiate the PA request to the appropriate PA department by phone or fax