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Author: Admin | 2025-04-28
The list of medications under the 7-day short-term dispensing reimbursement model? anticonvulsants antidepressants antimanic agents antipsychotics benzodiazepines contraceptives estrogens needles & syringes nicotine replacement therapy progestins smoking cessation stimulants Q5. What is the list of medications under the 28-day short-term dispensing reimbursement model? alpha-adrenoreceptor antagonists anticoagulants anti-dementia drugs antiemetics for cancer chemotherapy anti-gout drugs antihistamines anti-platelet anti-parkinsonian drugs benign prostatic hyperplasia (BPH) drugs cardiovascular drugs drugs for diabetes drugs for treatment of bone diseases enzyme preparations gastrointestinal (GI) anti-inflammatory drugs H2-receptor antagonists immunosuppressants non-steroidal anti-inflammatory drugs (NSAIDs) over-the-counter (OTC) products (including vitamins) other drugs for peptic ulcer and gastro-esophageal reflux disease (GERD) prokinetic agents proton pump inhibitors respiratory smooth muscle relaxants synthetic antidiuretic hormone thyroid therapy urinary antispasmodics Q6. What are the exceptions to the 2 short-term dispensing reimbursement models? The short-term dispensing policy does not apply to medications under these circumstances: refills for intermittent treatment of a chronic disorder or refills of a medication which are prescribed to be taken on an "as needed" (PRN) basis. Note: Medications prescribed to be taken on an "as needed" (PRN) basis and dispensed chronically may be subject to audit and recovery prescriptions for dose changes injectable and suppository dosage forms refills or new prescriptions when prescribed/dispensed in accordance with a court order Q7. If the prescriber writes a prescription for 'daily dispense', is this sufficient documentation to allow for a full dispensing fee? No. A prescription with the direction of 'dispense daily' or 'daily dispense' is not a sufficient rationale for the program to reimburse differently than as described in the NIHB short-term dispensing policy. The dispensing frequency is at the discretion of the prescriber and pharmacist. However, compensation under the NIHB program is based on program policies. Q8. What happens if the pharmacy dispenses the classes of medications listed above more frequently than once every 7 or 28 days depending on the medication class? The dispensing fee should be submitted according to the following formula: [(usual and customary dispensing fee (up to NIHB maximum) /7 or 28 days) x days supply]. The dispensing frequency is at the discretion of the prescriber
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