Due to the current state of emergency in the state and to ensure that Medicaid beneficiaries have access to the medications they need, the Department of Vermont Health Access (DVHA) is temporarily re-activating SCC 13 as an allowable NCPDP submission clarification code in the adjudication of pharmacy claims. Changes to point-of-sale will be effective from July 13, 2023, to July 25, 2023. This code is utilized by the dispensing pharmacist when processing an early refill for the patient and indicates that an override is needed based on an emergency/disaster situation recognized by the payer. The use of SCC 13 will override a Reject 79 (Refill too soon). It will not override either Reject 75 (prior authorization required) or Reject 76 (Plan limits exceeded). DVHA will monitor claims using this submission clarification code to ensure it is used only when medically necessary. Improper use of SCC13 will subject the claim to recoupment. For questions, please contact the Change Healthcare Pharmacy Help Desk at 1-844-679-5362. Vermont providers can also send inquiries via email to PBA_VTHelpdesk@changehealthcare.com.
On July 20, Gov. Phil Scott (R) signed the 3rd addendum to his emergency declaration. This addendum added the following relevant to pharmacies: “The Secretary of State is hereby directed to waive such rules and requirements as may be necessary to allow a pharmacist to extend a previous prescription for up to a 30-day supply for a maintenance medication for which the patient has no refills remaining or for which the authorization for refills has recently expired if it is not feasible to obtain a new prescription or refill authorization from the prescriber. “Maintenance medication” means a prescription drug taken on a regular basis over an extended period to treat a chronic or long-term condition. The term does not include a regulated drug, as defined in 18 V.S.A. § 4201.” Additionally, a pharmacist who extends a prescription for a maintenance medication pursuant to this authority shall take all reasonable measures to notify the prescriber of the prescription extension promptly.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.