IMPORTANT INFORMATION ABOUT MANAGED MEDICAID PHARMACY BENEFIT

Dear Provider:

As you know, this year’s State budget crisis is the worst in over a decade. Difficult decisions on cost reductions had to be made. In February 2009 the State introduced a “Generic Drugs First Pharmacy Benefit” for patients enrolled in the RIteCare program. Effective October 1, 2010 that same “Generic Drugs First Pharmacy Benefit” will be extended to all other Managed Medicaid populations including Rhody Health Partners (RHP), Children with Special Healthcare Needs (CSN), and Substitute Care (SC). 

Beginning October 1, 2010, the pharmacy benefit for RHP, CSN and SC members will cover generic drugs only. Exceptions have been made for a limited number of brand name drugs for certain therapeutic classes of drugs (see fact sheet). On a case-by-case basis, additional brand name drugs may be available based on medical necessity and demonstrated lack of efficacy of the generic drug. Medical necessity reviews will be available according to Neighborhood’s protocols and Formulary. 

This change does not affect patients with traditional Medicaid Fee For Service coverage.

Neighborhood will send letters to all of its RHP, CSN and SC members informing them of the “Generic Drugs First Pharmacy Benefit” in late August. In addition, Neighborhood will send second letters to its RHP, CSN and SC members that will have to switch to a different drug and will need a new prescription.  Neighborhood will also send letters to physicians identifying those members who will be impacted by this change.

For more information, please contact Neighborhood Customer Service at 1-401-459-6020 or 1-800-459-6019, Monday through Friday, from 8:30AM to 5:00PM.

We recognize that this change may raise concerns for some RHP, CSN and SC members. We are asking for your assistance in making this transition as smooth as possible. Thank you for your continued effort in providing quality health care to Rhode Island’s children and families enrolled in the RHP, CSN and SC programs.

Fact Sheet