August 13, 2024
On August 6, 2024, Commissioner Causey released a bulletin to remind health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions. (The bulletin followed Gov. Cooper’s declaration of a state of emergency due to Tropical Storm Debby on August 5, 2024.)
Specifically, health benefit plans are required to have a procedure in place to waive time restrictions on filling or refilling prescriptions for medication if requested by the covered individual. This includes waiving electronic “refill too soon” edits and ensuring payment to the pharmacy in accordance with the prescription benefit plan and applicable pharmacy provider agreement. Further information on the state’s requirements for coverage of extra prescription drugs during a state of emergency or disaster.
This authorization of extra prescriptions is valid for prescription medication requests made within 29 days of the bulletin’s issuance unless extended by an order issued by the Commissioner.
Prescription drug plan sponsors should be aware of this recent bulletin.
State of Emergency Bulletin for Tropical Storm Debby
PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.
Subscribe