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Issue Alert - 04-04-03

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Date:

Apr 01, 2004

Issue Summary:

100-day Supply for Maintenance Medications

Persons Affected:

Medicaid recipients taking prescription medication

For More Information:

Center for Civil Justice 320 S. Washington, 2nd Floor Saginaw, MI 48607 (989) 755-3120, (800)724-7441 (989) 755-3558 FaxE-mail: info@ccj-mi.org or


Background

Medicaid

What's Happening?

Under the Medicaid program, prescriptions must be filled according to certain guidelines. For acute illness:· The amount dispensed must be limited to the quantity required for that episode of illness or up to a 34-day supply.For chronic illness:· Maintenance drugs must be dispensed in quantities as ordered by the physician and to achieve optimum therapy and economy of dispensing, or up to a 100-day supply.Prior authorization is required to dispense a 100-day supply of maintenance medications that are beneficiary-specific and not on the maintenance list. If prior authorization is denied, the client can request an administrative hearing with the Department of Community Health.See DCH Bulletin Pharmacy Chapter III Updates

What Should Clients Do?

If you are a Medicaid recipient and you have been denied any medication prescribed by your doctor or switched to a different medication because of new restrictions placed on access to drugs by the Department of Community Health, you are entitled to protest that denial before an Administrative Law Judge. In order to do so, you must file a request for a Medicaid fair hearing with the Department of Community Health. The toll free number is (877) 833-0870; Fax: (517) 335-9180.

Finding Help

Most legal aid and legal services office handle these type of cases, and they do not charge a fee. You can locate the "free" legal services or legal aid office that serves your county on the Michigan LawHelp web site (http://MI.LawHelp.org) or look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.