http://www.hfs.illinois.gov/assets/090412n.pdf
According to this INFORMATIONAL NOTICE from HEALTH AND FAMILY SERVICES.. Most/all Medicaid pts in Illinois are limited to FOUR PRESCRIPTIONS per running 30 day period.
There are a few exceptions to this rule:
Birth Control – the state doesn’t want any more mouths to feed
Cancer Drugs, HIV drugs, Immunosuppressives, Antibiotics
There is a specific list of drugs that MAY BE GRANTED reimbursement for via a prior approval process.
So, it would appear, in Illinois .. if you are on Medicaid… unless you have a need for drug for immediate life threatening situation… or for something that would cause the system a short term expense (Birth Control & Antibiotics).. as opposed to long term life threatening … Hypertension, Diabetes, Lipids, etc..etc..etc.. you are at the mercy of the bureaucracy and making “medical determinations” based on what is submitted on “paper”. Isn’t it consider illegal/unethical for a practitioner to prescribe medication for a patient without doing a hands on exam… If one is allowing/denying medication without a hands on exam of the person involved… if it is a nurse… could he/she be guilty of practicing medicine without a license or if a legal prescriber… be guilty of some sort of ethical/legal violation of their practice act?
It will be interesting if this is just another bureaucratic process.. intending to save money… when all it does …is spend more money trying to save money…
Filed under: General Problems
Tennessee has that as a 5 script limit. The exemptions to it are certain inexpensive blood pressure meds, ie HCTZ, metoprolol, etc. This has been in effect for about 7+ years. It still doesn’t discourage weekly ER visits for hydros. On top of that, Tenncare (Tn’s Medicaid) only pays $4 reimbursement on most generic meds.
West Virginia tried this years ago and it was a tremendous flop!!