Generic Elidel (pimecrolimus 1% cream) SCC 02 override for shortages
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Temporary authorization allowing pharmacies to use submission clarification code (SCC) 02 to bypass prior authorization for pimecrolimus 1% cream (generic Elidel) when a true wholesaler shortage of the brand exists; applies to Kentucky Medicaid pharmacy providers served by MedImpact.
Pharmacy providers are temporarily authorized to enter SCC 02 to bypass prior authorization for pimecrolimus 1% cream when a true shortage of the preferred brand Elidel exists.
Coverage Criteria
SCC 02 override criteria
Conditions under which SCC 02 may be used to bypass prior authorization:
ALL of the following
- Preferred brand Elidel 1% cream is not available from the wholesaler (a true shortage).
- Pharmacy submits the claim using submission clarification code (SCC) 02 to bypass prior authorization for pimecrolimus 1% cream.
- Adequate documentation of the wholesaler shortage is obtained and retained; documentation is strongly recommended because inappropriate use may be audited.
- SCC 02 override functionality is used on or after July 15, 2024 and only for the duration of the temporary authorization until further notice.
Affected Product / Coding
| pimecrolimus 1% cream | Generic for Elidel 1% cream (product affected by SCC 02 override) |
Provider Actions and Billing
SCC 02 override for pimecrolimus 1% cream
Pharmacy providers may enter Submission Clarification Code (SCC) 02 to bypass prior authorization for pimecrolimus 1% cream (generic for Elidel) when a true shortage of the preferred brand Elidel exists. This override becomes available July 15, 2024; adequate documentation of the shortage is strongly recommended and inappropriate use may be subject to audit.
- SCC 02 override usable only when the preferred brand product is not available from your wholesaler (a true shortage).
- Override functionality available beginning July 15, 2024.
- Adequate documentation of the shortage is strongly recommended; inappropriate use may be audited.
Definitions
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