California

Filling for Higher Than Ordered Quantity

The state allows dispensing of a Quantity Filled that is greater than the Quantity Ordered. This is especially helpful if you want to dispense 90-day fills for your patients.

Label Regulations

As of recent mid 2016 regulations, the following must be completed for CA labels:

Critical Elements

These four following elements must be placed on the label in the specified order at 12 point sans-serif (fonts like Arial) font. They should be either BOLD to stick out, or spaced away from other elements. Bold will be more practical.

• Name of the patient

• Name of the drug and strength of the drug

• SIG Directions

• Condition or purpose of the medication if the condition or purpose is indicated on the prescription

Any other element should be not interfering with the critical elements, and that can be easily avoided by ensuring the fields are not too close to the required fields and using the BOLD strength on the critical elements.

Colorado

Filling for Higher Than Ordered Quantity

The state allows dispensing of a Quantity Filled that is greater than the Quantity Ordered. This is especially helpful if you want to dispense 90-day fills for your patients.

Florida

Filling for Higher Than Ordered Quantity

The state allows dispensing of a Quantity Filled that is greater than the Quantity Ordered. This is especially helpful if you want to dispense 90-day fills for your patients.

Prescription Refill Transfer

Florida allows for a single refill transfer out to a pharmacy, in case the patient wants to come back for subsequent refills.

Illinois

Prescription Tax

Prescription drugs are taxed at the state level, but at a reduced state rate of 1%. All drugs (prescription and nonprescription) are tax exempt at the local level.

Refill Expiration Date

Refill expiration in the state of Illinois is 15 months after written date; this can be changed on the individual insurance plan's Miscellaneous screen if need be.

Louisiana

Prescription Tax

Prescription drugs are tax exempt at the state level, but local areas can opt to tax them.

Michigan

Generic/Brand Label Requirement

The state of Michigan requires that the prescribed drug is included in the "Generic for" message, therefore label variable 178/180 will automatically convert to variable 924. Variable 925 can also be used as it includes the prescribed drug or brand name if prescribed drug is not included and is generally a better choice.

New Jersey

New Jersey NCPDP D.0 Addendum to EDI Agreement

This agreement is required for all pharmacies to stay in compliance when submitting claims to NJ Medicaid, stating all transactions are true, accurate, and complete, and sent in the appropriate D.0 format. Below you will find answers to the BestRx related questions on the application.

Instructions for filling out this form

1. Section 1
   Fill out your pharmacy’s information here. For Question 8, if you do not know your Submitter ID, call us
   at 630‐893‐9210 and we will show you where you can find it.

2. Section 2
   Question 10 – Select the option for Version D.0 Telecom

3. Section 3
   Please call for up to date information.

4. Section 4
   Question 24 – Enter a value of “1” for the Relay Health option, “2” for the Emdeon option for most BestRx pharmacies, unless known/advised otherwise.

Software Vendor/Certification ID for NJ Medicaid

NJ Medicaid requires that the proper Software Vendor/Certification ID be submitted on claims. This can be entered into the Insurance Plan File for NJ Medicaid.

The ID format is NJP + your pharmacy’s 7 digit submitter number. For example, if your submitter number is 1234567, you would enter NJP1234567 into the field.

BestRx’s support team does not record or manage your submitter number; if you do not know it, please reach out to New Jersey Medicaid’s support line for assistance.

New Jersey D.0 Other Payer IDs

For a number of Coordination of Benefit claims in the state of New Jersey, a valid and proper Other Payer ID (OP ID) has to be passed through to the secondary payer in order to properly identify the primary payer. Please refer to the chart below for the possible codes and their corresponding plans. When setting up COB and Secondary Payer for these situations, these codes should ideally be entered in the Patient's File (F3) Insurance Plans. If you're unsure how to perform this process, please call and one of the technicians will be able to assist you.

Project Medicine Drop

Notice Regarding Drug Take Back Programs

Frequently Asked Questions (NJ Consumer Affairs Website)

 P.L. 2015, c.66, which becomes effective on January 1, 2016, requires prescribers and pharmacies to provide a notice about drug take back programs upon dispensing to each patient a controlled dangerous substance (CDS) prescription medication. Specifically, the new law requires:

Prescribers to furnish to each patient, with any CDS prescription drug or medicine dispensed for that patient as permitted pursuant to N.J.S.A. 45:9-22.11, a notice prepared by the Division of Consumer Affairs; and

Pharmacies that dispense prescription drugs (other than long-term care pharmacies) to distribute, with any CDS prescription medication that is dispensed to an individual located in New Jersey, a notice prepared by the Division of Consumer Affairs.

A copy of the notice prepared by the Division is available for download on the Division's website at:

o        NJConsumerAffairs.gov/meddrop/Documents/Unused-Medications.pdf (English)

o        NJConsumerAffairs.gov/meddrop/Documents/Unused-Medications-Spanish.pdf (En Español).

In order to comply with the requirements of P.L.2015, c.66, prescribers and pharmacies must do one of the following:

1. Download the Division notice from the Division's website and provide a hardcopy to the patient;

2. Download the Division notice from the Division's website and email an electronic copy to the patient; or

3. Post a copy of the Division notice in a conspicuous location and insert the following text in another document (for example, the prescription drug monograph) that is provided to the patient:

SAFE and SECURE MEDICINE DISPOSAL
Unused medications that remain in your medicine cabinet are susceptible to theft and misuse. To prevent medications from getting into the wrong hands, New Jersey's Office of the Attorney General and Division of Consumer Affairs urge you to properly dispose of your expired and unwanted prescription medicine at a nearby Project Medicine Drop location.  DROP OFF IS SIMPLE, ANONYMOUS AND AVAILABLE 24 HOURS A DAY – 365 DAYS A YEAR, NO QUESTIONS ASKED. Simply bring in your prescription and over-the-counter medications and discard them in an environmentally safe manner. Always scratch out the identifying information on any medicine container you are discarding. For a list of Project Medicine Drop locations, please visithttp://www.njconsumeraffairs.gov/meddrop.

New York

Prescription Refill Transfer

Florida allows for a single refill transfer out to a pharmacy, in case the patient wants to come back for subsequent refills.

EPCS Registration for ERx

Pharmacies must register their certified Electronic Prescribing of Controlled Substance (EPCS) software application with the Department of Health, Bureau of Narcotic Enforcement (BNE), and renew every two years thereafter. The registration process is available online through the Health Commerce System (HCS). This online application is called ROPES: Registration for Official Prescriptions and E-prescribing Systems.

How to access ROPES and register EPCS Software:

1. Login to the Health Commerce System at https://commerce.health.state.ny.us/

2. Select "My Content" at the top of the page

3. Scroll down and select "All Applications"

4. Scroll over and select "R"

5. Scroll down and select “Registration for Official Prescription and e-Prescribing Systems (ROPES)”

6. Choose Pharmacy or Pharmacy Chain that needs to register software and click "SELECT"

7. Add Contact Information and click "SAVE"

8. Review Pharmacy & Contact Information, if correct click "REGISTER EPCS SOFTWARE"

9. Enter certified EPCS software information or select software from the dropdown menu

10. Enter Software Version; as of January 2018, BestRx is on version 5.8

11. Read Attestation and click "I ATTEST" if you agree with the EPCS Attestation

Additional information regarding electronic prescribing of controlled substances may be found at the following link: Electronic Prescribing

Should you have any questions about ROPES, please contact BNE by email at narcotic@health.ny.gov or by phone at 866-811-7957.

Exceptions to Electronic Prescribing

The following circumstances allow a practitioner to issue an ONYSRx or oral prescription, for controlled or non-controlled substances.

NOTE: The practitioner is not required to indicate the circumstance on the written or oral prescription. The pharmacist is not required to verify the reason for a written or oral prescription.

• Approved waiver from electronic prescribing+

• Nursing home or RHCF defined in Article 2801 of the Public Health Law

• Complicated directions

• Directions longer than 140 characters

• Compounded prescriptions containing two (2) or more products

• Compounded infusion prescriptions containing two (2) or more products

• A prescription containing certain elements required by the Federal Food and Drug Administration (FDA), such as an attachment

• Approved protocols under expedited partner therapy

• Approved protocols under collaborative drug management

• Response to a public health emergency that would allow a non-patient specific prescription

• Approved research protocol

• A non-patient specific prescription for an opioid antagonist

• Veterinarian

• Temporary technical failure

• Temporary electronic failure

• The prescription will be dispensed out-of-state, including federal installations such as Veteran Administration Facilities, Fort Drum & West Point

• Patient harm If the practitioner determines that an electronic prescription cannot be issued in a timely manner and that the patient’s condition is at risk

New York Medicaid

Use this worksheet to help with any issues you might have while transmitting to New York Medicaid.

Bin Number: 004740

PCN: PIN + 3 or 4 character ETIN

Both of these values are provided by NY Medicaid. If you do not know one of these values, you will need to contact NY Medicaid to obtain them.

If your pharmacy was previously sending NY Medicaid claims and you accidentally changed the PCN number in your file, check the NY Medicaid PIN and NY ETIN fields in the BestRx program on the File > 11. Pharmacy Setup screen. If this information was entered here previously, you can take it and place it in the PCN field in the Insurance Plan screen. If this information needs to be corrected and the PCN field in the Insurance Plan file is not changing to the correct values, please give BestRx support a call to adjust it manually.

Although you will only have 7 or 8 characters in the PCN field for NY Medicaid, when the claim is sent, it will send 10 characters. The extra 2 characters will come from the RPh initials of the person filling the Rx, the software will add the 10th automatically. Only the first and last initials of the RPh will be used. If the middle initial is there, it will be dropped.

Examples:

• If the PCN is 3893F7Y4 (8 characters) and the RPh initials are AZ, then the PCN that is sent will be AZ3893F7Y4 (AZ + 3893 + F7Y4). The RPh initials are appended to the front of the number.

• If the PCN is 3893F7Y (7 characters) and the RPh initials are AZ, then the PCN that is sent will be YAZ3893F7Y (Y + AZ + 3893 + F7Y). When a 10th character is needed, a Y is appended to the front of the number as mentioned above.

Dual Billing

When setting up dual billing with NY Medicaid as the secondary plan, you need to have the following:

• 03 for the OP ID Qualifier and BIN number for OP ID

• 05 for the OP ID Qualifier and 99 for the OP ID if the primary plan is Medicare Advantage

• 99 for the OP ID Qualifier

• 99 for the OP ID if the primary plan is a commercial plan or a Medicare Part D plan

• 13 for the OP ID if the primary plan is a Medicare Part B plan (such as OmniSys, EZDME, Allwin)

Medicaid Number and HCPCS Codes

As of January 2013, New York Medicaid no longer accepts DME formatted claims and requires a third party company to translate these claims before adjudication. If you are not currently signed up with a Medicare Part B translation company such as OmniSys, refer to our important contact information menu to obtain the telephone number and website of these agencies.

Billing for OTC Items without a Prescriber

NY Medicaid allows for you to bill certain OTC items (such as emergency birth control) without an actual prescription from a doctor. To bill these claims, you need to submit to NY Medicaid without sending any prescriber info. There is a simple way to do this in the BestRx system.

Create a dummy prescriber, giving it whatever name you want (such as NYMED, OTC). When creating this prescriber, make sure you leave the DEA, NPI, State License, UPIN and Medicaid MMIS fields blank.

When filling the prescription for the OTC item, select the dummy prescriber that was created for this purpose.

When saving the prescription, the user may be prompted to warn them that you are sending a claim without the prescriber’s NPI. When that prompt appears, the user should choose the option that allows them to continue submitting the claim without the prescriber NPI.

Send the claim and if all the Patient and Drug info is correct, the claim should go through.Note: In the File -> 11. Pharmacy Setup Screen on the Misc (page 2) tab, there is an option called Action when transmitting w/o Prescriber NPI. Make sure this option is NOT set to Don’t Allow Transmission. If it is set to this option, the BestRx system will not allow any claims to be sent without a prescriber NPI.

Old Regulations

Control Triplicate Number

For prescriptions in New York, this value can be found on the actual written prescription itself, the one that came from the prescriber. This value will be accompanied by a barcode and it currently (as of August 2012) consists of 8 alpha-numeric characters.

Prescriptions pads in the state of New York are regulated. Each prescription sheet has a unique control triplicate number. It allows the government to track any possible fraudulent prescriptions or stolen prescription pads.

If you have a barcode scanner, you can scan the barcode when the cursor gets to the appropriate field. It is good practice for the pharmacy to enter the control triplicate number for every prescription, but in reality it is only required for NY Medicaid claims and controlled prescriptions.

There will be certain situations where a written prescription is not available so there will be no control triplicate number. In these situations, you will need to use one of the following values, depending on the circumstance:

• Faxed prescriptions - EEEEEEEE

• Electronic prescriptions - EEEEEEEE

• Oral/Telephone prescriptions - 99999999

Prescriptions written by out of state prescribers - ZZZZZZZZ (out of state prescribers do not have access to the special prescription pads used by NY prescribers, so therefore they would not have a valid control triplicate number on them)

Prescriptions on carve-out drugs for nursing home patients - NNNNNNNN

Prescription Labels

Critical Elements

• Patient Name

• Drug Name

• SIG Directions

In addition, the following fields (important elements) must also be on the label. But these field must NOT be in bold because that would distract attention away from the fields they categorize as "critical elements".

Important Elements

• Pharmacy Name

• Pharmacy's Full Address (with the city, state, zip)

• Pharmacy Phone Number

• Patient's Full Address

• Prescriber Name

• Fill Date

• Rx Number

If there is room on the sticker, additional info that is not categorized as a "critical element" or "important element" may be placed on the label, but this info must NOT be in bold because that would distract attention away from the fields they categorize as "critical elements".

Texas

More Than 5 Refills of C3-C5 Medication

Texas pharmacies are not allowed to dispense any more than 5 refills of any C3-C5 medication, despite nationwide regulations.

Filling for Higher Than Ordered Quantity

The state allows dispensing of a Quantity Filled that is greater than the Quantity Ordered. This is especially helpful if you want to dispense 90-day fills for your patients.

Texas Label Regulations

The state of Texas requires the "Do not flush" message to appear on all labels. The variable in the BestRx label designer for the warning label is 217/227.

They require an easily readable font size, that must closely match but be no smaller in size than ten-point Times Roman.