Rx_Prescription Drug Coverage In Assisted Living And Long Term Care
Notification to provider partners and dispensing pharmacies that Neighborhood Health Plan expects use of plan formularies for members in assisted living and long-term care facilities and requires prior authorization for non-formulary or restricted medications, including OTCs.
Affirms expectation that providers use Neighborhood formularies and requires prior authorization for non-formulary or restricted medications for assisted living and long-term care members.
Policy Overview
Background: Neighborhood News bulletin reminding providers that Neighborhood expects use of plan drug formularies to ensure safe and cost-effective treatment for members residing in assisted living and long-term care facilities.
Scope summary: Notification to provider partners and dispensing pharmacies that providers must utilize Neighborhood formularies when creating drug treatment plans for assisted living and long-term care members and that Prior Authorization is required for non-formulary or restricted medications, including over-the-counter (OTC) drugs. The most up-to-date formularies are posted by line of business on the payer website at www.nhpri.org/providers/provider-resources/pharmacy/. Dispensing pharmacies may request that providers submit a Prior Authorization prior to placing an override and dispensing.
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