016-06-05 Ark. Code R. § 78

Current through Register Vol. 49, No. 6, June, 2024

Rule 016.06.05-078 - Prescription Drug Coverage for Dual Eligibles Covered By Medicare - DMS-2005-O-1, DMS-2005-G-2, DMS-2005-II-3, DMS-2005-L-3, DMS-2005-KK-2, DMS-2005-Q-2, DMS-2005-R-3, DMS-2005-OO-2

Effective January 1, 2006, due to the change in federal law, Arkansas Medicaid will no longer cover prescription drugs for the dual eligible population. Dual eligibles are those persons with Medicare who receive prescription drug coverage through Medicaid. Medicare will begin to pay for their prescription drugs through a Medicare approved prescription drug plan (PDP).

A claim submitted to Arkansas Medicaid with a date of service on or after January 1, 2006 for a Medicare eligible patient will deny at point of sale indicating the drug is non-covered (edit Y700).

A small number of drugs are excluded from Medicare coverage under the new federal law. For excluded select drugs only, to which a reference is listed on back of this page, Arkansas Medicaid will be required to reimburse if a PDP does not.

When a claim is submitted by the pharmacy for a covered drug in the category on the back of this page, the pharmacy will receive edit Y701with an error message requiring the pharmacy to bill Medicare first. If a claim is denied by Medicare and the PDP does not pay for an equivalent drug in the class, the claim will be paid by Arkansas Medicaid. The pharmacy will be required to enter the Medicare denial date into the Third Party Liability (TPL) denial date field (443-E8 Other Payer Date).

The following excluded drugs are covered, as set forth on the Arkansas Medicaid Website at www.medicaid.state.ar.us under the following link, "Medicare Part D Excluded -- Allowed by Arkansas Medicaid":

a. select agents when used for weight gain b. select agents when used for the symptomatic relief of cough and colds c. select prescription vitamins and mineral products, except prenatal vitamins and fluoride d. select nonprescription drugs e. select agents when used to promote smoking cessation f. barbiturates g. benzodiazepines Coverage of these drugs by Arkansas Medicaid for the dual eligibles will be subject to any criteria as established for the regular Medicaid population.

Thank you for your participation in the Arkansas Medicaid Program.

Roy Jeffus, Director

If you need this material in an alternative format, such as large print, please contact our Americans with Disabilities Act Coordinator at (501) 682-6789 and 1-877-708 -8191. Both telephone numbers are voice and TDD.

If you have questions regarding this notice, please contact the EDS Provider Assistance Center at In-State WATS 1-800-457 -4454, or locally and Out-of-State at (501) 376-2211.

Arkansas Medicaid provider manuals, official notices and remittance advice (RA) messages are available for downloading from the Arkansas Medicaid website: www, medicaid, state, ar. us.

016.06.05 Ark. Code R. § 078

12/1/2005