Hospital Discharge Transition Fill

June 2014

Important Note: Inpatient hospital pharmacies, hospital discharge pharmacies and outpatient pharmacies are encouraged to regularly consult the Minnesota Health Care Programs (MHCP) Preferred Drug List and work together to stabilize MHCP enrolled recipients on preferred medications during the course of hospitalization. Using preferred medications from the first fill will minimize the overall administrative burden for the pharmacy, the facility, and DHS.

Authorization will be granted for one fill if:

• Recipient was discharged from the hospital and the prescription was written as part of the recipient’s hospital discharge orders AND
• The drug requested is eligible for coverage under state and federal law (rebating manufacturer, covered category, etc.) AND
• The drug requested is not a brand name for which a generic product is available AND
• The recipient is not enrolled in Medicare Part D OR
• The recipient is enrolled in Medicare Part D and the requested drug is an excluded category under Part D but is covered under MHCP

Authorization for additional fills will be granted only if the recipient meets the MHCP drug-specific PA criteria.

Rationale

The transition fill policy was developed to better facilitate care of recipients newly discharged from hospitalization.

The transition fill policy minimizes the possibility of treatment disruptions for fragile medical conditions while still encouraging adherence to DHS treatment criteria over time.

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411