The Department of Health announced Monday that effective March 3, Medicaid will pay for eight prescriptions per patient per month. However, the proposed plan allows physicians to override a patient’s limit if that person is dependent on multiple medications. LDH also has initiated a new Web-based tool that allows physicians and pharmacists access to the prescription history of Medicaid patients, ensuring that informed medical decisions are made when any prescription is ordered.
This plan is a modified version of a plan the department decided against last month that limited Medicaid recipients to eight prescriptions per month, with no override, exempting people who had certain medical conditions. LDH originally intended for the plan to make necessary reductions in its budget but retracted it after hearing from several concerned citizens and legislators.
Under the new plan, the department can cut Medicaid costs while providing necessary medications for patients who need the extra prescriptions to maintain their health.
"The health of our Medicaid patients has always been an important concern for the department, and I am pleased we have a plan in place that will make necessary budget reductions while maintaining their health and quality of life," said Secretary David W. Hood.
The new plan also exempts certain patients from the limit, including children (younger than 21), people who reside in long-term care facilities and pregnant women. Otherwise, if physicians determine additional prescriptions are medically necessary, they can take steps to override the limit.
If physicians do choose to prescribe more than eight medications, they must present certain documentation, including valid medical codes and condition assessments that determine a "medically necessary override," to the pharmacist filling the prescription. The pharmacists and prescribers both are responsible for keeping documentation of medically necessary overrides.
Until now, Medicaid patients have received unlimited prescription drugs. However, Medicaid patients in Louisiana use nearly 50 percent more prescriptions than the nationwide average. Many states, including Arkansas, Texas and Mississippi, have prescription limits in place, with most limiting patients to less than eight per month. LDH decided to enact a Louisiana prescription limit to avoid a deficit for the 2003 fiscal year.
The state will enact this plan following approval of the U.S. Department for Health and Human Services and the Centers for Medicare and Medicaid Services