How to force a med formula change in Medicaid

[valhead]

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Obese 9 year old. Mother thought she could do the pill Zpack. Swallowed 1st then up came the first and 2nd after 2nd pill swallow. Doc called in liquid and Medicaid won't pay because it should cover 5 days. What's the work around or is it simply out of pocket?

 

[steveysmith54]

depends on your state. In California, you can submit a Treatment Authorization Request (TAR) with medical justification for any medication request or override.

 

[Sine Cura]

It depends on the coverage too. You can submit a TAR for fee-for-service Medi-Cal but managed care plans have their own override process (usually a PA by the prescriber)

 

[rockpharm]

Wait for five days and bill it--tell patient you did them a favor and that you will call them when it goes through so that the parent can come in and pay. If it's Medicaid, you will probably just need a signature.