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Pharmacy Non-Controlled Substance Overrides

March 2011

Override/authorization is granted in the following circumstances

Circumstance

Action

Recipient does not reside in a LTC facility such as a nursing home or ICF/DD and one of the following occurred with the medication:

• Lost

• Stolen

• Damaged

• Destroyed

Authorization is granted once every 12 months

Prescriber increased the dose of the medication

Verify with the prescriber and document that the dose was increased

Pharmacy entered the wrong days supply on the first fill

Reverse the claim and rebill

Change in living arrangement such as the recipient was admitted to or discharged from a nursing home

Verify and document the change in living arrangement

The facility kept the medications that were taken from the recipient and the recipient was discharged/released from a:

• Hospital

• Correctional facility

• Detoxification center

Verify and document the discharge/release from the facility

Recipient enters a detoxification facility for the purpose detoxification only

Authorization will be granted for only the exact amount needed for the detoxification stay. The detoxification facility must order, pick up and maintain control of the medication.

Recipient must travel and will not return before the next anticipated prescription fill date

A vacation/travel override will only be allowed after 50% of the last supply’s days have passed.

Authorization is granted once every 12 months.

The maximum allowed override is a 34 day supply.

Recipient requires a refill override to allow a medication supply at camp.

Authorization is granted.

The maximum allowed override is a 34 day supply.

Override/authorization is not granted in the following circumstances

Circumstance

Action

Recipient resides in a LTC facility such as a nursing home or ICF/DD and medication was:

• Lost

• Stolen

• Damaged

• Destroyed

The facility must replace the medication at its own cost

Recipient increased the dose of the medication

Authorization will not be granted

Recipient received authorization once within the last 12 months because one of the following occurred with the medication:

• Lost

• Stolen

• Damaged

• Destroyed

Additional authorization will not be granted

Recipient received authorization once during the last 12 months due to travel

Additional authorization will not be granted

Pharmacy is trying to be reimbursed for

• Pass meds

• School supplies

• Work supplies

• Etc

Authorization will not be granted

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