Wisconsin Chronic Disease Program
 Prescriber
Letter on Brand Name Drug Reimbursement Changes
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October 18, 2004
Dear Doctor:
Effective for dates of service on or after July 1, 2004, WCDP
reimburses brand name drugs at the Medicaid reimbursement rate. Prior to
this change the state-funded WCDP reimbursed drugs at the generic rate for
brand name drugs when a generic was available even if the prescription was
for a brand name drug.
To assure that brand name drugs are dispensed only when medically
necessary, WCDP has developed the following procedures based, in part, on
procedures used by Medicaid, BadgerCare and SeniorCare. Effective November
15, 2004, when a brand medically necessary prescription is written,
prescribers are expected to submit a completed Food and Drug
Administration (FDA) MedWatch Voluntary Reporting form, which can be found
at http://www.fda.gov/medwatch/,
with the prescription to the pharmacy. Prescribers are to do the
following:
- Continue to write "Brand Medically Necessary" on the prescription.
(Phrases like "No substitutes" or "N.S." are not acceptable.) This
certification must be in the prescriber’s own handwriting and written
directly on the prescription or on a separate order attached to the
original prescription. Typed certification, signature stamps, or
certification handwritten by someone other than the prescriber does not
satisfy this requirement.
- Complete the MedWatch Reporting form. Documentation on the MedWatch
form must indicate how the brand name drug will prevent reoccurrence of
the adverse or allergic reaction or therapeutic failure.
These requirements do not apply to refills for prescriptions written
prior to November 15, 2004. A copy of the completed MedWatch form does not
need to be submitted to WCDP for prior authorization. The program reserves
the right to conduct a post payment review to ensure brand name drugs are
appropriately dispensed. Providers should retain the MedWatch form in the
participant’s medical file. Prescribers are responsible for providing
pharmacies with the completed MedWatch form. If you have any questions
regarding this letter, please contact WCDP at (608) 221-3701.
Sincerely,
James J. Vavra, Director
Bureau of Fee-For-Service Health Care Benefits
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Last Revised:
January 26, 2005
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