Medicaid Prescription Refill Rules

Medicaid is a health service provider that is funded by the federal government and the state.  It includes medical and health related programs for qualified Americans. But not all states provide prescription drug coverage. Only thirty-three states and the District of Columbia render this coverage for all Medicaid members. In those states, refilling for prescription drug varies.  Medicaid has established rules for medical practitioners, including doctors and pharmacists, and Medicaid beneficiaries ought to be aware of the restrictions on RX and should never tamper with prescriptions. This will prevent fraud, and can eliminate waste and mix-up while in Medicaid transaction.

Each state has its own ordinances for refilling and dispensing prescription drugs. It depends on the state rules for who’s going to be in-charge for the refill and who will obtain the approval of the prescription refill and how this will be carried out.

If the pharmacy receives a request for a refill, they can refill it only if there are refills left from the original prescription.  Prescription legal validity or dating is only applicable for a year after the prescription was written. The validity for Schedule III-V prescription drug is good for only six months in almost all states.  The quantity of refills doesn’t matter as long as it is under the dating of the prescription.  Then a new prescription must be rendered after a year.

If the original prescription is empty, a refill authorization from the physician must be presented when requesting a refill. If the physician is not available or not around when you request for the authorization, an assigned agent that is hired by medical practitioner is there to assist in handling the prescription drug order.

A pharmacist is authorized is by the state law to obtain information about the patient medication record before refilling the prescription. Some states allow pharmacy interns to do the same as to pharmacist receiving and refilling jobs. The pharmacist needs to screen or to do the Drug Utilization Review (DUR). In this process, the pharmacist will require you to supply some basic health information like gender, age, or date of birth, allergies, drug reactions and chronic conditions.  They are also responsible for the validity of the information presented to them may it be through telephone call or facsimile copy of the prescription refill authorities form or renewals. The refill you can get depends on the quantity of medication written on the prescription. The physician can decide to give you a larger quantity of prescription drug if it is appropriate in your medical condition. Exercising clinical judgment by pharmacists in filling prescription drug is expected.

Most states have conditions for emergency filling and limits on number of refills to be supplied. A seventy-two hour supply is authorized if the refill is out but the patient must provide new prescription from the physician to go on with the drug intake. The patient cannot receive an indefinite or an open prescription.

If you see that your prescription drug needs a refill soon, you better contact your pharmacy.  There are pharmacies that refill all medications during office hours only. They need an exact record of all medications and patient medical records to check within state and federal laws and prescribing guidelines.