23 Miss. Code. R. 214-1.4

Current through December 10, 2024

Rule 23-214-1.4 - Prior Authorization

A. The Division of Medicaid requires prior authorization of certain covered drugs to ensure use as approved by the Food and Drug Administration (FDA) for specific medical conditions.

1. Prior authorization of drugs must be obtained from the Division of Medicaid's Pharmacy Prior Authorization Unit or its designee before the drug may be dispensed.

2. All prior authorization requests must be submitted electronically via web-portal or by facsimile.

3. Only the Mississippi Medicaid enrolled prescribing provider or a member of the provider's staff may request prior authorization.

4. Prior authorization requests submitted by agents of drug manufacturers will be denied.

B. The Division of Medicaid reimburses for a seventy-two (72) hour emergency supply of a prescribed drug when a medication is needed without delay and prior authorization is not available and applies to all drugs requiring a prior authorization either because they are:

1. Non-preferred drugs listed in the Preferred Drug List (PDL), or

2. A drug affected by clinical or prior authorization edits which would need prescriber prior approval.

23 Miss. Code. R. 214-1.4

42 USC § 1396r - 8(d)(5); Miss. Code Ann. §§ 43-13-117(A)(9), 43-13-121, 73-21-129.

Revised Miss. Admin. Code Part 214, Rule 1.4.A.1-B.2 eff. 07/01/2013