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Connecticut has recently notified pharmacies and prescribing providers that various quantity limits and refill criteria will revert back to pre-COVID 19 requirements come May 21, 2021. The reinstatement of pre-COVID 19 requirements anticipates the scheduled May 20 expiration of Connecticut’s public health emergency. The changes appear in Connecticut Medical Assistance Program Provider Bulletin 2021-24 issued earlier this month by the Connecticut Department of Social Services (DSS).
When the changes take effect, the maximum allowable units and days’ supply for prescriptions that are non-maintenance drugs and not controlled substances will drop from ninety (90) to thirty (30). Prescriptions authorized under Connecticut General Statues section 20-616, that is prescriptions refilled without an order based upon a pharmacist’s exercise of their professional judgment to avoid an interruption in a therapeutic regime or patient suffering, will only be refillable in a quantity not to exceed a seventy-two (72) hour supply. There is an exception to this limit for prescriptions for certain diabetes drugs and devices. The exception allows for up to a thirty (30) day supply if specific criteria are met.
Early refill rules also change effective May 21. A prior authorization will be required when a pharmacy submits a Connecticut Medicaid Program claim where a patient has consumed less than ninety-three percent (93%) of the original or latest refill prescription. This early prescription refill criteria applies to prescriptions filled for a daily supply of sixteen (16) days or greater. For prescriptions supplied for fifteen (15) days or less an eighty-five percent (85%) utilization threshold applies as is the case for pharmacy claims submitted by out of state pharmacy providers.
Five-dollar ($5) co-pays for generic drugs and ten dollars ($10) for brand drugs return for HUSKY B recipients. DSS is additionally reinstating the Medicare Part D co-pay requirements for dual eligible HUSKY Low Income Subsidy individuals. Persons covered under a HUSKY Benefit Plan will be responsible for the first seventeen dollars ($17.00) per month of their Medicare Part D co-pays.
Questions about these changes may be addressed to the author.
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About Our Connecticut Health Law Blog
Alerts, commentary and insights from the attorneys of Pullman & Comley’s Health Care practice on legal developments affecting hospitals, physician groups, pharmaceutical and medical device companies as well as other health care providers and suppliers.