Replacement Medication for Family PACT Clients Impacted by the State of Emergency
August 20, 2020
Pharmacy and clinic providers must dispense the full amount of the requested medication covered under the Family Planning, Access, Care and Treatment (Family PACT) Program immediately if the need to dispense is related to the client’s displacement or subjection to fires and extreme fire weather conditions or public safety power shutoff.
This includes drugs that may require a Treatment Authorization Request (TAR). The need for a TAR should not negatively affect the decision to dispense the full amount of the required medication immediately and the TAR can be submitted retroactively. Providers are instructed to incorporate the statement “Patient impacted by fires and extreme fire weather conditions or public safety power shutoff” within the Miscellaneous Information field on the TAR for those drugs or situations requiring a TAR. It is imperative that the impacted client receive the full amount of the necessary medication in a timely manner to facilitate compliance and to not cause a delay or break in therapy.
TARs for medications (new, refill or replacement), if required, will be automatically approved if the TAR indicates that the client is impacted by fire, or by power shutoffs, and the provider will be paid for the claim for the dispensed medications. The negative impact of the fire or power shutoff, alone, will meet the criteria of medical necessity.
Providers are encouraged to monitor the Medi-Cal website for future updates.