- (1) Upon the recommendation of the Pharmacy and Therapeutics (P&T) Committee, DIH pharmacy staff select the therapeutic classes and select the most clinically effective and cost effective drug or drugs within each class.
- (2) The prescriber must obtain prior authorization from the Department to dispense drugs designated as "non-preferred" in each class, through the Department's current prior authorization system. Criteria for a Non-preferred Prior Authorization (NPA) is established by the Department in consultation with the P&T Committee.
- (3) A prior authorization is not placed on any preferred drugs under Section R414-60B-4. Nevertheless, a prior authorization may apply if set by the Drug Utilization Review Board (DURB).
- (4) For NPA requests submitted during normal business hours, Monday through Friday, 8 a.m. to 5 p.m., the prior authorization system shall provide either telephone or fax approval or denial within 24 hours of the receipt of the request.
- (5) In an emergency situation for a prior authorization needed outside of normal business hours, a 72-hour supply of a non-preferred drug may be dispensed and the Department shall issue an NPA for the 72-hour supply on the next business day. Further quantity requests shall be subject to all NPA requirements.
KEY: Medicaid
Date of Last Change: June 19, 2025
Notice of Continuation: May 31, 2022
Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-105; 26B-3-108