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You are Here: Home Page > Mandatory Generic Drug Program > Information for Pharmacists - Mandatory Generic Drug Program  

Information for Pharmacists - Mandatory Generic Drug Program

• The dispensing pharmacist is required to call the toll free telephone number 1-877-309-9493 prior to dispensing, and validate the prior authorization number which is written on the prescription. The Pharmacy Worksheet and Instructions (PDF, 40KB, 2pg) provide step-by-step assistance for the pharmacist to complete this process.
• Dispensing must occur on or after the date the prior authorization number is issued and within 60 days of the order date otherwise the claim will not be paid.
• If the brand-name drug is not dispensed by a pharmacy within 60 days of the order date, the prior authorization number will expire. The pharmacy will be given a message to contact the prescriber to determine if their patient has a current need for the drug.
• The eleven-digit prior authorization number must be entered in the prior authorization field when submitting the claim. Prior authorization does not guarantee payment. Payment is subject to patient eligibility and other Medicaid guidelines.
• After validating the prior authorization number, the claim may be submitted electronically by placing the correct information into the prior authorization code field. The NCPDP format for this field uses the number "1" followed by the eleven digit numeric prior authorization number. Please check with your software vendor prior to submitting a claim regarding the specific process to be used to submit the required prior authorization number. No more than two claims can be submitted in one electronic transaction if there are different prior authorization numbers. If the claim is submitted manually, only the eleven-digit prior authorization number is required for the prior authorization field.
• Verify and enter all prior authorization numbers and NDCs correctly on the claim. The prior authorized NDC must exactly match the NDC of the drug dispensed to submit the claim.
• If a prior authorization number has not been obtained by the prescriber and the pharmacist or recipient has attempted but is unable to reach the prescriber, and an emergency exists, the pharmacist may obtain a prior authorization for up to a three-day emergency supply of a brand-name drug (subject to other State laws and Medicaid restrictions). The Pharmacy Emergency Supply Worksheet and Instructions (PDF, 31KB, 2pg) assist the pharmacist in completing the prior authorization process. The pharmacist is expected to follow-up with the prescriber to determine future needs. Once the pharmacist obtains the prior authorization number, dispenses and bills the emergency three-day supply, the prescription is no longer valid for any remaining quantity.