Replacement Drug Needed

Last updated 5 years ago First published 18 April, 2017

medication replacement

Health English Rating: Above 18 Shortest path: 5 nodes Longest path: 11 nodes Possible solutions: 12
Greg S testing out decision flows and training time
  • Is it a Non-Formulary or an Narcotic Med. No. Yes.
  • Narcotic or Non-Formulary. Non-formulary. Narcotic.
  • Member to Call Prescriber for RxPA submission.
  • Have existing PA on file. No. Yes .
  • Can process override.
  • Member to Call Prescriber for RxPA submission, go back to top of tree and answer NO to NF/Narc question.
  • Drug has been Lost, Stolen or Vacation Overrride needed. Vacation Override. Stolen. Lost.
  • Check if already given a Replacement Med Override this calendar year, IEHP allows two. No, <2 overrides done this year. Yes , Two Overrides already done this year.
  • Member to Call Prescriber for RxPA submission.
  • Can process based on Days Supply Restrictions. Maintenance Meds. Non-Maintenance Med.
  • 90 days.
  • 30 days.
  • Police Report Filed? Yes, report filed. NO, Report filed .
  • Member to call police and report the Stolen medications and then call back to IEHP for override.
  • Process Override .
  • <=7 days prior to Vacation. No more than 7 days . Yes.
  • Call back when <=7 days to Vacation date.
  • How long Member plans to be gone. 31 or more days . <30 days.
  • Process Override.
  • > 60 days. Yes. No .
  • Can only process 60 days supply for non maintenance meds, residency requirement for IEHP.
  • Process Override.