Fla. Admin. Code Ann. R. 59G-4.255 - Prescription Drug Coverage Denials

(1) Medicaid-participating pharmacies shall provide the pamphlet, Important Information About Your Florida Medicaid Prescription Drug Benefits, 10/03/05, or Información Importante A cerca de sus beneficios de medicamentos con receta del Medicaid de la Florida, 11/01/05, which are incorporated by reference, to Medicaid recipients whose prescription drug claims are denied by Medicaid if the pharmacy cannot resolve the denial during that day's pharmacy visit. The pharmacy must write on the pamphlet the date, the recipient's name, the drug name, and the reason for the denial or write on the pamphlet the date and recipient's name and attach a printout of the computer screen stating the drug name and the reason for the denial. The pamphlets are available from the Agency for Health Care Administration's website at http://ahca.myflorida.com/Medicaid/Prescribed_Drug/multi_source.shtml.

(2) Medicaid-participating pharmacies shall post two signs, Important Notice to Medicaid Recipients, 5/14/2004, and Aviso Importante a Recipientes de Medicaid, 5/14/2004, which are incorporated by reference, in a conspicuous location that is visible to recipients. The signs inform recipients of a toll-free number that can be called if the prescription is denied and the pharmacy failed to provide the denial information and an Important Information About Your Florida Medicaid Prescription Drug Benefits or Información Importante A cerca de sus beneficios de medicamentos con receta del Medicaid de la Florida pamphlet to the recipient. The signs are available from the Agency for Health Care Administration's website at http://ahca.myflorida.com/Medicaid/Prescribed_Drug/multi_source.shtml.

Notes

Fla. Admin. Code Ann. R. 59G-4.255

Rulemaking Authority 409.902, 409.919 FS. Law Implemented 409.902, 409.906, 409.919 FS.

New 3-2-06.

New 3-2-06.