Common use of Member Transition of Care for Prescription Drugs Clause in Contracts

Member Transition of Care for Prescription Drugs. The MCP is responsible for implementing transition of care processes that prevent access problems for members that are transitioning from the FFS pharmacy benefit administrator to an MCP. The transition of care processes must be prior approved by ODM and at a minimum include the following: i. The MCP may not require prior authorization (PA) of prescriptions filled according to paragraph ii. below, until the MCP has educated the member that further administration will require the prescribing provider to request PA and, if applicable, the option of using an alternative medication that may be available without PA. Written member education notices must use ODM-specified model language. Verbal member education may be done in place of written education but must contain the same information as a written notice. MCP member notices and call scripts must be prior approved by ODM. ii. For new members who transition from FFS to an MCP, the MCP may not require PA in the first month of membership, for at least one prescription refill for claims approved by Ohio Medicaid during the prior FFS enrollment period. iii. For antidepressant and antipsychotic medications, the MCP must abide by the restrictions on PA described in Appendix X.0.x.xx of this Agreement.