M E M O R A N D U M

IM-51 3/13/01  MC+/MEDICAID PHARMACY THIRD PARTY LIABILITY


SUBJECT:
MC+/MEDICAID PHARMACY THIRD PARTY LIABILITY
 
DISCUSSION:
Effective April 1, 2001, pharmacists will begin asking MC+/Medicaid recipients if they have private insurance.  The pharmacy must seek reimbursement from other private health insurance plans payment sources prior to any payment being made by the state Medicaid agency.  DMS told pharmacies of this requirement in a March 1, 2001 Pharmacy Bulletin.

On March 2, 2001, DMS mailed a notice of this requirement to all MC+/Medicaid Recipients that appear in the TPL system as having private insurance with a pharmacy benefit.  A copy of the notice is attached.  Have staff familiarize themselves with this notice.  If notified by a recipient that they no longer have pharmacy coverage, send a TPL-1 to DMS.

This may result in additional inquiries from recipients and/or pharmacies. 
NECESSARY ACTION:
  • Share this memorandum with appropriate staff.
GS
Distribution #6
                                                                           Case DCN: 

IMPORTANT NOTICE FROM MISSOURI MC+/MEDICAID

Dear

          Our records show you or someone in your household has a private insurance plan that pays for drugs.  Starting April 1, 2001, your pharmacist will ask you if you have a private insurance plan other than MC+ or Medicaid.  Starting April 1, 2001, the pharmacy will have to bill the private insurance plan before they bill Medicaid. 

           It is your responsibility to show all providers and pharmacists both the red MC+ or Medicaid card and the private insurance plan card.  You should ask your provider or pharmacist if they take both cards.

           If your private insurance plan has a limited list of pharmacy providers, you must go to a pharmacy on that list or in that insurance plan.  Medicaid will be responsible for any cost sharing amounts such as copays.  If you go to a pharmacy that is not on you private insurance plan's list of providers, you may have to pay all or part of the bill.  If you go to a pharmacy that is not on you private insurance plan's list of providers, the pharmacy can deny you service.

          If you do not have private insurance that pays for drugs, you must call your Division of Family Services caseworker to have it taken off your records.  You may also call the recipient services agent toll free at 1-800-392-2161 or long distance at (573) 751-6527 to have private insurance taken off your records.

          If you have any questions please contact:

Recipient Services Agent
PO Box 3535
Jefferson City, MO 65102-3535
1-800-392-2161 (Toll Free)
573/751-6527
Thank you for your cooperation.


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