Drug - Retroactive Eligibility
July 2011
Authorization will be granted for generic when brand is the preferred agent if:
The authorization for the generic drug will be limited to the retro eligibility period.
Nursing Home Retroactive Eligibility
Important Note: Pharmacies serving nursing home residents are encouraged to consult the Minnesota Health Care Programs (MHCP) Preferred Drug List in advance of filling prescriptions for MHCP-eligible residents or residents who may be pending MHCP eligibility. Using preferred medications from the first fill will minimize the overall administrative burden for the pharmacy, the facility, and DHS.
Authorization will be granted for nursing home retroactive eligibility if:
In order to meet retroactive eligibility criteria, recipients must NOT be enrolled in MHCP on the date of dispensing. If the patient was enrolled in MHCP but the pharmacy did not check eligibility on the date of dispensing, the prescription must meet MHCP drug-specific PA criteria for payment approval.
Authorization for additional fills will be granted only if the recipient meets the MHCP drug-specific PA criteria.
MHCP Provider Call Center 651-431-2700 or 800-366-5411