CT HB06360

Department of Social Services must provide written notice to Medicaid recipients when payment for a prescribed drug is electronically denied, either in-person at the pharmacy or by mail within 24 hours of denial.

Denial notices must identify the specific drug, explain the reason for denial, state the regulatory basis, describe the hearing request process, and explain alternative actions to obtain the drug or a substitute.

Medical practitioners who issued denied prescriptions must receive written notice within two business days, including whether denial was due to failure to obtain prior authorization.

If denial is due to lack of prior authorization, the Department must provide practitioners with names of equally effective drugs that do not require prior authorization and contact them again if no drug is dispensed within 12 calendar days.

The act takes effect October 1, 2011 and amends Section 17b-274 of the general statutes.