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Emergency Supply of Medications
All Maryland Medical Assistance
fee-for-service and HealthChoice recipients are entitled to
receive a 72-hour supply of medicine while awaiting prior
authorization or approval to dispense a non-formulary,
non-preferred or brand name medication (for which there is a
generic equivalent drug is available). A 30-day supply is
allowed for atypical antipsychotic medications while awaiting
prior authorization for a non-preferred or Tier 2 drug.
If the prescriber is unavailable to either
change the medication or obtain preauthorization, or if the
prior authorization process is not completed, all Maryland
Medicaid HealthChoice Managed Care Organizations (MCOs) and the
Maryland Medicaid fee-for-service Pharmacy Program will cover a
minimum 72-hour supply of drugs.
Pharmacists should use their professional
judgment in determining whether the prescription is needed on an
emergency basis. The recipient may present mobility or
access issues that make returning to the pharmacy very difficult
or expensive. The pharmacist should take this factor into
consideration when deciding whether or not it is critical to
dispense an emergency supply.
It will be necessary for the pharmacist to
request authorization to dispense an emergency supply of a
prescription by calling a 24/7 telephone number. In the case of
sprays, inhalers, eye or ear drops, creams, ointments,
antibiotics etc., it may be necessary to dispense the entire
prescription as an emergency supply due to the way the drug is
packaged or administered.
For HealthChoice MCO and PAC members
requiring an emergency supply of non-mental health and
non-antiretroviral drugs, the pharmacist must contact the
appropriate MCO Pharmacy Benefit Manager and follow their
procedures before dispensing an emergency supply.
In the case of fee-for-service recipients or
for mental health and antiretroviral drugs covered by the State,
the number to call to obtain authorization to dispense an
emergency supply is 800-932-3918. During the 72-hour window,
the pharmacist is to contact the prescriber who must obtain
prior authorization before the remainder of the prescription can
be dispensed. After prior authorization has been
established, the pharmacist can dispense the remainder of the