Alabama Reminder to follow both state and federal law: Medicaid Rule No. 560-X-16-.20(5)

Alabama Medicaid Rule No. 560-X-16-

.20(5) Quantity Limitations

(5) Maintenance medications are those generally used to

treat chronic conditions or illnesses and are ordered/pre

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scribed and taken regularly and continuously. Medicaid

recipients can obtain a three month supply of maintenance

medications as designated by the Agency. The patient

must first have demonstrated stability for at least 60

days (same strength and dose) on a given maintenance

medication. Only one co-pay is collected and only one

dispensing fee is paid for the three month supply. A list

of maintenance medications is available on the Medicaid

website.

Medicaid has disseminated and posted guidance to the

Alabama Medicaid Agency website, which is very clear in that

pharmacists should always follow both state and federal phar

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macy law. The Alabama Medicaid Agency guidance is avail

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able on its website at

www.medicaid.alabama.gov/documents/

4.0_ Programs/4.5_ Pharmacy_ Services/4.5.4_ Drug _ Info/

4.5.4_Maintenance_Supply_Guidance_Revised_9-5-13.pdf

and states the following: “Alabama State Board of Pharmacy 

 

law prohibits the quantity of a prescription to be changed

without prescriber approval. Approval from the prescriber

must be attained prior to dispensing a maintenance supply."

quoted from here