Nursing Home Transition Fills

August 2009

Important Note: Pharmacies serving nursing home residents are encouraged to consult the Minnesota Health Care Programs (MHCP) Preferred Drug List in advance of filling prescriptions for MHCP-eligible residents. Using preferred medications from the first fill will minimize the overall administrative burden for the pharmacy, the facility, and DHS.

Authorization will be granted for one fill if:

• Recipient is a newly admitted resident of a nursing home AND
• The drug requested is eligible for coverage under state and federal law (rebating manufacturer, covered category, etc.) AND
• The drug requested is not a brand name for which a generic product is available AND
• The recipient is not enrolled in Medicare Part D OR
• The recipient is enrolled in Medicare Part D and the requested drug is an excluded category under Part D

Authorization for additional fills will be granted only if the recipient meets the MHCP drug-specific PA criteria.

Rationale

The transition fill policy was developed to accommodate the unique business and clinical needs of LTC pharmacies, facilities, and residents.

Long Term Care Pharmacies are responsible for ensuring the timely delivery of prescriptions so that residents’ treatment plans are not disrupted. To accomplish timely delivery, it is common practice for medications to be packaged and delivered to the facility before billing takes place. The transition fill policy minimizes the possibility of treatment disruptions for fragile residents while still encouraging adherence to DHS treatment criteria over time.

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411