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memo Upon Receipt Prilosec OTC a

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									STATE OF WEST VIRGINIA

DEPARTMENT OF HEALTH AND HUMAN RESOURCES
Bob Wise Governor Paul L. Nusbaum Secretary

MEMORANDUM
DATE: TO: FROM: SUBJECT: March 10, 2004 Long-term Care Pharmacy Providers Peggy A. King, R.Ph. Pharmacy Director Prilosec OTC and Claritin for Nursing Home Residents

This memo is to clarify coverage of Prilosec OTC and Claritin OTC for residents of nursing homes and Intermediate Care Facilities for the Mentally Retarded. Over-the-counter drugs are currently included in the per diem payment made to long term care facilities. However, the Medicaid Preferred Drug List now includes Prilosec OTC and Claritin OTC products which are available without prior authorization. It has come to our attention that non-coverage of these OTC products has caused some confusion in regard to reimbursement for these preferential drugs. Until the necessary program changes are made, these products will not process through the pharmacy point-of-sale system, but can be directly billed to the nursing facility who will in turn will pass the charges on to Medicaid in their cost reports. When computer programming changes have been implemented, Prilosec OTC and Claritin OTC products will be reimbursed through the pharmacy point-of-sale system for long term care residents. A Program Instruction will be sent to providers to notify them of this change. Should you have any questions regarding this memo, please feel free to contact me at (304) 5581700.

Bureau for Medical Services Office of Pharmacy Services 350 Capitol Street, Room 251 Charleston, West Virginia 25301-3707 Telephone: (304) 558-1700 FAX: (304) 558-1542


								
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