GS has limited the number of fills to five per year for maintenance drugs. \u00a0GS will deny claims that are for less than 3 months.<\/p>\n
This does not apply to non-maintenance drugs like anti-psychotics.<\/p>\n
<\/p>\n
For any patient that has 5 or more maintenance drugs, less than 3 months supply will be allow (patients that have complicated drug therapy). \u00a0For blister patient, GS will only pay for 7 or 14 days supply, not 28.<\/p>\n
If patient requires more frequent dispensing due to cognitive impairment or other issues, pharmacies can submit a request to GS for an exemption.<\/p>\n
AS per Green Shield<\/p>\n
Effective February 1, 2016, GSC will limit the number of fills to five per year for maintenance drugs included in the list below. Claims for drugs that GSC has deemed to be maintenance will be denied if dispensed for less than a three-month supply; the response code from the GSC system for these claims will be: \u201cDR = days supply lower than minimum allowable.\u201d The use of an applicable intervention code will be allowed in individual situations where dispensing of a three-month supply may not be appropriate at that time. Use of the intervention codes listed below will be subject to audit and must be supported with relevant documentation on the prescription hard copy. ER = override days supply limit for period MN = replacement claim due to dose change MY= long term care Rx split for compliance For patients requiring ongoing, more frequent dispensing \u2013 due to a cognitive impairment or other issue \u2013 an exception request form (available on GSC\u2019s providerConnect website) must be submitted outlining the clinical rationale supporting the request. GSC\u2019s pharmacy team will review the request, and where appropriate, grant an exemption to the policy.<\/p>\n","protected":false},"excerpt":{"rendered":"
GS has limited the number of fills to five per year for maintenance drugs. \u00a0GS will deny claims that are for less than 3 months. This does not apply to non-maintenance drugs like anti-psychotics. For any patient that has…<\/span><\/p>\n