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"We are currently working to identify vendors capable of providing script pads which will be fully 2008 compliant, but as of 10/1/2007 one of the three "industry recognized standards" or documentation of verbal confirmation by the prescriber documented on the face of the prescription must be incorporated on written Medicaid scripts to ensure reimbursement by the State. I agree that it is unfortunate that pharmacies bear the brunt of the legislation, when it is incumbent upon the prescriber to comply, but that is the way the law is written and once again pharmacies are the easy target to ensure compliance.

I cannot stress enough the importance of pharmacies working with prescribers to fax or call in scripts, or come up with other creative methods to ensure compliance. Our Prudent Audits will be required to look for compliance, so when a prescription is audited after 10/1/2007 pharmacies need to ensure it is compliant with the new law to avoid recoupment. Unfortunately the clients will ultimately be impacted as they are turned away by some pharmacies unwilling to assume the risk or unwilling to call for verification."

Roger A. Citron, R.Ph.
Montana DPHHS

Thank you Roger for your guidance during these critical times!

Montana Medicaid Notice
Physicians, Mid-Level Providers, Dentists,
Pharmacies, and Inpatient and Outpatient Hospitals
Tamper-Resistant Prescription Pads — UPDATED

The Centers for Medicare and Medicaid Services (CMS) released guidance to state Medicaid programs regarding a new law requiring the use of Tamper-Resistant Prescription Pads. Beginning October 1, 2007, all written Medicaid prescriptions must be on Tamper-Resistant prescription pads. This requirement applies to all outpatient drugs, including over-the-counter medications, regardless of whether Medicaid is the primary or secondary payor. Prescriptions may still be telephoned, faxed, or transmitted electronically (e-prescribed) to pharmacies as allowed by current federal and state regulations.

Initial Department guidance issued September 7th proposed the use of indelible ink in an alphanumeric format. Though the Department determined this met the intent of the law, CMS issued an additional Frequently Asked Questions (FAQ) document which stated this practice was not acceptable.

CMS provided further guidance that written orders prepared in an institutional setting where the patient never has the opportunity to handle the written orders are considered “tamper resistant.” The CMS guidance and FAQ documents are posted at the Department’s web-site: http://medicaidprovider.hhs.mt.gov/pdf/trpfaqs.pdf

The Tamper Resistant Pad requirement does not apply to drugs which are “bundled” or not separately reimbursed in conjunction with services provided in nursing facilities, intermediate care facilities, and other specified institutional and clinical settings as described by 42 USC 1927 (k)(3) http://www.ssa.gov/OP_Home/ssact/title19/1927.html.
This requirement does not apply to refills of prescriptions written before October 1, 2007.

Requirements and Guidance
Montana Medicaid encourages prescribers to telephone, fax or electronically transmit prescriptions to pharmacies.
Beginning October 1, 2007, CMS will require that a Medicaid prescription pad shall contain one of the following three characteristics:

1. One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form;
2. One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber, and
3. One or more industry-recognized features designed to prevent the use of counterfeit prescription forms.

Beginning October 1, 2008, a written Medicaid prescription must contain all three characteristics.

Pharmacies may fill the full prescription of covered outpatient drugs written on non-compliant prescription pads, or a portion thereof at the pharmacist’s discretion. However, pharmacies must verbally confirm the non-compliant prescription and document the call on the face of the prescription, or obtain a faxed, electronic, or compliant written prescription within 72 hours of the date the prescription was filled.

The Department is compiling a list of vendors which can produce compliant pads. This list shall be posted on the DPHHS web page and updated regularly as new vendors are identified. This list is not exclusive and prescribers may contact the Department to confirm the acceptability of their tamper resistant pad.

Schedule II (CII) Drugs
Schedule II prescriptions must be in writing to comply with DEA and Montana Board of Pharmacy regulations specified in ARM 24.174.523. While pharmacies cannot fill faxed or verbal CII prescriptions, prescribers can use these methods to provide confirmation to pharmacies. In accordance with CMS guidance, faxed or verbal confirmation will render the CII prescription, written on non-tamper resistant paper, compliant.

Enforcement
Currently, the Federal law and CMS guidelines apply only to Medicaid clients’ prescriptions. It will be essential to identify any Medicaid eligibility at the time the prescriptions are written and/ or filled to ensure that those prescriptions comply with the applicable rules. CMS requires the States to enforce the tamper resistant pad requirement. The Department is developing audit procedures to ensure compliance.

Verifying Client Eligibility
There are several eligibility verification methods available using the client member number/card control number printing on the Montana Access to Health Card.

• Web Portal: https://mtaccesstohealth.acs-shc.com/mt/general/home.do will provide
online eligibility information. Registration as a provider is necessary.
• FAXBACK 800-714-0075: Returns a copy of the client’s eligibility when given the client’s identification number, via fax to the provider within a couple of minutes after ending the call. Please make sure your fax number is on record with ACS to use this free service.
• AVRS (Automated Voice Response System) 800-714-0060: Provides the client’s eligibility
and billable identification number through an automated voice system.
• Provider Relations Department 800-624-3958 (in-state) 406-442-1837 (Helena and outof- state): Verify eligibility with Provider Relations Monday-Friday from 8 am to 5 pm.
Please direct any questions regarding this notice to the following personnel: Physician and Mid-Level providers: Denise Brunett at (406) 444-5778; Dentists: Jan Paulsen at (406) 444-3182;
Pharmacy providers: Wendy Blackwood at (406) 444-2738; Hospitals: Debra Stipcich at (406) 444-4834.

Contact Information
For claims questions or additional information, contact Provider Relations:
Provider Relations toll-free in- and out-of-state: 1-800-624-3958
Helena: (406) 442-1837
Visit the Provider Information website:
http://www.mtmedicaid.org/