Updated on 01/11/2019

Original article posted on CAHSAH Weekly News Update – November 19, 2018

In response to the fires in Butte, Los Angeles and Ventura counties, the Department of Health Care Services (DHCS) has issued the following information about the need to dispense replacement medication to beneficiaries impacted by these fires.

Pharmacies are advised to submit a Treatment Authorization Request (TAR) using the Special Handling of “Six Prescription Limit” and incorporate the statement “Patient impacted by [identify specific county] county fire” within the Miscellaneous Information field on the TAR.

If a pharmacy receives a real-time claim denial for frequency limitation, the pharmacy is advised to submit a TAR using the Special Handling of “Exceeded Billing Frequency Limit” and incorporate the statement “Patient impacted by [identify specific county] county fire” within the Miscellaneous Information field on the TAR.

DHCS has authorized reimbursement of a 72-hour supply of covered Medi-Cal drugs in an emergency situation. California Welfare and Institutions Code (W&I Code), Sections 14133.37 and 14185 requires pharmacies to dispense up to a 72-hour supply of covered medication(s) at no charge to Medi-Cal beneficiaries in an emergency situation. This includes prescriptions waiting for a TAR approval.

Claims for the emergency supply must be submitted for reimbursement through the completion of the Pharmacy Claim Form (30-1) and include the submission of an Emergency Certification Statement as described in the Pharmacy Claim Form (30-1) Completion section of the Pharmacy provider manual. Providers must incorporate the following statement within the general emergency statement: “Patient impacted by [identify specific county] county fire.”