Effective June 1, 2018, the Indiana Health Coverage Programs (IHCP) will cover pharmacy-only transports for IHCP
members served through the fee-for-service (FFS) delivery system, subject to limitations established for certain benefit
packages.
Pharmacy-only transports are allowed when transport is the only option available to obtain prescriptions. This coverage change applies to FFS members for dates of service (DOS) on or after June 1, 2018.
Pharmacy-only transports are counted toward a member’s transportation benefit limit of 20 one-way trips per rolling 12-month period. Prior authorization (PA) is required when a member exceeds his or her benefit limitation.
Prescribers and providers are encouraged to help minimize the need for members to make pharmacy-only trips to obtain prescriptions in the following ways:
Prescribe maintenance drugs with 100 days’ supply
Encourage members to fill prescriptions at the outpatient pharmacy of the medical facility or office location of the prescriber, if available
Use mail-order pharmacy services for prescriptions, if available
Coordinate a member’s prescriptions or prescription refills so they can be picked up in a single trip, if possible
Encourage members to fill prescriptions on return trips from medical appointments (A stop at a pharmacy when returning home from a medical appointment will not count against a member’s transportation service limits.)
Transport to a pharmacy for pickup of prescriptions may be unavoidable under the following urgent situations:
A prescription must be filled immediately (for example, insulin or other medications that could have serious side effects if not administered).
There was an error when the prescription was initially filled (for example, the client was given the wrong medication).
The member’s condition will deteriorate if the prescription is not filled within 12 hours.
Beginning June 1, 2018, nonemergency medical transportation (NEMT) services for most IHCP members served through the FFS delivery system will be brokered by Southeastrans. See IHCP Bulletin BT201816 for details. Providers rendering transportation services, including pharmacy-only transports, brokered through Southeastrans will submit claims for reimbursement to Southeastrans. Contact Southeastrans toll-free at 1-855-325-7586 with related questions.
Transportation services, including pharmacy-only transports, rendered to FFS members that are not required to be brokered through Southeastrans, will be reimbursed through DXC Technology. Providers should follow normal FFS billing guidelines for claim submission.
Coverage of pharmacy-only transports for members enrolled in Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise, and other managed care programs is determined by the individual managed care entities (MCEs). Related questions should be directed to the MCE with which the member is enrolled.
Pharmacy-only transports are allowed when transport is the only option available to obtain prescriptions. This coverage change applies to FFS members for dates of service (DOS) on or after June 1, 2018.
Pharmacy-only transports are counted toward a member’s transportation benefit limit of 20 one-way trips per rolling 12-month period. Prior authorization (PA) is required when a member exceeds his or her benefit limitation.
Prescribers and providers are encouraged to help minimize the need for members to make pharmacy-only trips to obtain prescriptions in the following ways:
Prescribe maintenance drugs with 100 days’ supply
Encourage members to fill prescriptions at the outpatient pharmacy of the medical facility or office location of the prescriber, if available
Use mail-order pharmacy services for prescriptions, if available
Coordinate a member’s prescriptions or prescription refills so they can be picked up in a single trip, if possible
Encourage members to fill prescriptions on return trips from medical appointments (A stop at a pharmacy when returning home from a medical appointment will not count against a member’s transportation service limits.)
Transport to a pharmacy for pickup of prescriptions may be unavoidable under the following urgent situations:
A prescription must be filled immediately (for example, insulin or other medications that could have serious side effects if not administered).
There was an error when the prescription was initially filled (for example, the client was given the wrong medication).
The member’s condition will deteriorate if the prescription is not filled within 12 hours.
Beginning June 1, 2018, nonemergency medical transportation (NEMT) services for most IHCP members served through the FFS delivery system will be brokered by Southeastrans. See IHCP Bulletin BT201816 for details. Providers rendering transportation services, including pharmacy-only transports, brokered through Southeastrans will submit claims for reimbursement to Southeastrans. Contact Southeastrans toll-free at 1-855-325-7586 with related questions.
Transportation services, including pharmacy-only transports, rendered to FFS members that are not required to be brokered through Southeastrans, will be reimbursed through DXC Technology. Providers should follow normal FFS billing guidelines for claim submission.
Coverage of pharmacy-only transports for members enrolled in Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise, and other managed care programs is determined by the individual managed care entities (MCEs). Related questions should be directed to the MCE with which the member is enrolled.
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