Replacement Drug Needed

Last updated 7 years ago

First published 18 April, 2017

medication replacement

English Rating: Above 18 Shortest path: 5 nodes Longest path: 11 nodes Possible solutions: 12

Greg S testing out decision flows and training time

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Is it a Non-Formulary or an Narcotic Med. Yes. No.
Narcotic or Non-Formulary. Narcotic. Non-formulary.
Member to Call Prescriber for RxPA submission.
Have existing PA on file. Yes . No.
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. Lost. Stolen. Vacation Override.
Check if already given a Replacement Med Override this calendar year, IEHP allows two. Yes , Two Overrides already done this year. No, <2 overrides 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? NO, Report filed . Yes, 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. Yes. No more than 7 days .
Call back when <=7 days to Vacation date.
How long Member plans to be gone. <30 days. 31 or more days .
Process Override.
> 60 days. Yes. No .
Can only process 60 days supply for non maintenance meds, residency requirement for IEHP.
Process Override.