Post-Public Health Emergency – Connecticut Pharmacy Limitation Changes

Pullman & Comley - Connecticut Health Law
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Pullman & Comley - Connecticut Health Law

Connecticut has recently notified pharmacies and prescribing providers that various quantity limits and refill criteria will revert back to pre-COVID 19 requirements come May 21, 2021. The reinstatement of pre-COVID 19 requirements anticipates the scheduled May 20 expiration of Connecticut’s public health emergency. The changes appear in Connecticut Medical Assistance Program Provider Bulletin 2021-24 issued earlier this month by the Connecticut Department of Social Services (DSS).

When the changes take effect, the maximum allowable units and days’ supply for prescriptions that are non-maintenance drugs and not controlled substances will drop from ninety (90) to thirty (30). Prescriptions authorized under Connecticut General Statues section 20-616, that is prescriptions refilled without an order based upon a pharmacist’s exercise of their professional judgment to avoid an interruption in a therapeutic regime or patient suffering, will only be refillable in a quantity not to exceed a seventy-two (72) hour supply. There is an exception to this limit for prescriptions for certain diabetes drugs and devices. The exception allows for up to a thirty (30) day supply if specific criteria are met.

Early refill rules also change effective May 21. A prior authorization will be required when a pharmacy submits a Connecticut Medicaid Program claim where a patient has consumed less than ninety-three percent (93%) of the original or latest refill prescription. This early prescription refill criteria applies to prescriptions filled for a daily supply of sixteen (16) days or greater. For prescriptions supplied for fifteen (15) days or less an eighty-five percent (85%) utilization threshold applies as is the case for pharmacy claims submitted by out of state pharmacy providers.

Five-dollar ($5) co-pays for generic drugs and ten dollars ($10) for brand drugs return for HUSKY B recipients. DSS is additionally reinstating the Medicare Part D co-pay requirements for dual eligible HUSKY Low Income Subsidy individuals. Persons covered under a HUSKY Benefit Plan will be responsible for the first seventeen dollars ($17.00) per month of their Medicare Part D co-pays.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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