Branded Drugs - DAW
Drugs - Brand Name Drugs that have a Generic Equivalent
Authorization will be granted if the recipient has had a documented:
- Allergic reaction to a specific inactive ingredient in a generic
- Adverse reaction to a specific inactive ingredient in a generic
- Therapeutic success while taking the branded drug and therapeutic failure while taking the generic documented by patient diary or medical charted notes
- Obtain authorization for any brand name multiple source drug that has an FDA "AB" rated generic equivalent
- Handwrite "DAW - brand medically necessary" on the prescription and obtain authorization from MHCP Prescription Drug Prior Authorization Review Agent
- List the specific drug being requested, including:
- dosage form
- use directions
- Document when the generic was tried and the length of the trial period
- Provide specific clinical documentation of therapeutic failure on the generic whenever possible
- Describe the medical problem caused by the generic. Stomach ache and other non-descript symptoms are not adequate rationale.
MHCP Prescription Drug Prior Authorization Review Agent must have the MA Pharmacy provider number, the NDC for the drug, and the recipient MA ID number.
This process may be initiated by a faxed form or by telephone.
MHCP Provider Call Center 651-431-2700 or 800-366-5411