Issue Resolved - ADHD Preferred Meds Requiring PA

As of 12:30 a.m. this morning, this issue has been resolved. Claims for the preferred Antihyperkinesis agents should now process without requiring prior approval.

There had been an issue this week regarding pharmacy claims for the Antihyperkinesis class of medications. The preferred Antihyperkinesis agents DO NOT require prior approval (PA), but all of the claims for Antihyperkinesis agents (preferred and non-preferred) were rejecting for PHARMACY PA REQUIRED.

If you had previously contacted the NCTracks Pharmacy PA Unit to request a 30-day override of the ADHD medication that was being rejected, no further action is needed. If you have claims for preferred Antihyperkinesis agents that were denied for PA, they can now be resubmitted.

However, if you exercised the option to give the beneficiary a 72-hour emergency supply, some action is required. Since the 72-hour supply is for a C-II medication, the pharmacy will now have to obtain a new prescription or they can reverse the 72-hour supply claim and bill for the entire prescription quantity for the original prescription.