Can Medicaid cover my patients drug if the exception request was denied by my patients plan?
While Medicare Part D plans continue to be the primary payer for prescription drugs for dual eligible enrollees, as of January 1, 2007 New York State Medicaid will provide a wrap around benefit for the drugs in the following categories when coverage is not available under the Part D plan: atypical antipsychotics, antidepressants, antiretrovirals used in the treatment of HIV/AIDS, and immunosuppressants used in the treatment of tissue and organ transplant. Prescribers are expected to continue to work with their patient’s Medicare Part D plans utilizing the exception and appeal process in order to obtain coverage for necessary medications. Pharmacists may bill Medicaid after completing all the necessary CMS procedures to assure Medicare Part D coverage is available. If the drug is covered under Medicare Part B, and the enrollee is eligible for coverage, the pharmacist is required to seek coverage under Medicare Part B prior to billing Medicaid. All Medicaid rules apply to wrap around ben
Related Questions
- If a recipient has lost their prescription drug card and doesn remember what Plan they had, can Medicaid tell them what Drug Plan they were in?
- If my physician files an Exception Request and it is approved by CVS Caremark for a Level I or Level II drug, how long is the exception valid?
- Can Medicaid cover my patients drug if the exception request was denied by my patients plan?
