Over the past month, many pharmacies in Alabama have received DAW desk audits from MedImpact.  Their basis for these audits are centered around Alabama Code (1975) §16-25A-18, cited in Alabama Education Law.

“As a condition of participation in the Public Education Employees Health Insurance Programs (PEEHIP), a pharmacist shall dispense a generic equivalent medication to fill a prescription for a patient covered by PEEHIP when one is available unless the physician indicates in longhand writing on the prescription “medically necessary” or “dispense as written” or “do not substitute”.  The generic equivalent drug product dispensed shall be pharmaceutically and therapeutically equivalent and contain the same active ingredient, or ingredients and shall be of the same dosage, form and strength”

We believe this to be round one of what could potentially be a much larger scale audit across the state.  Until this matter is resolved please follow the steps listed below:

• Request that all physicians write Brand Medically Necessary in their own handwriting on the hard copy prescription
• For all "call-in" prescriptions ask the physician to hand write and fax you a copy stating Brand Medically Necessary
• For all E-Scribe prescriptions ask the physician to hand write and fax you a copy stating Brand Name Medically Necessary.

If you have already received this audit here are a few options for you to consider:

• Have the physician sign an affidavit stating they intended and still want their patient to have Brand Name.  The affidavit will have to contain the physician’s letterhead.
• Have the physician write a covering prescription with Brand Medically Necessary on the hard copy.

The above options are not a guarantee that audit findings will be over turned; however, these are our recommended options.  MedImpact will be meeting with PEEHIP to discuss whether an affidavit will be accepted.

At this time, the Alabama Board of Pharmacy and the Medical Association of the State of Alabama are working with PEEHIP to resolve this matter.  We are also working internally at APCI to see that this state law is amended to reflect the growth of E-Scripts.  PEEHIP understands the issue this law is causing for pharmacies and is in agreement that an amendment is needed.  We share a common goal of having the law amended during the 2016 Legislative session. When we receive any additional information we will forward on to you.