March 2010

 

DMA established a Preferred Drug List (PDL) on March 15, 2010 to obtian better prices for covered outpatient drugs through supplemental rebates. Initially, there will be NO changes in the drugs that are currently covered.  In the future, selected therapeutic drug classes will be reviewed and specific drugs defined as "preferred." Generally, these drugs will not require Prior Authorization(PA) unless there are other clinical PA requirements such as step therapy or quantity limits.

"Non-preferred" drugs will be available if prior authorization criteria are met.  The PA process will be the same as it is today.  The prescriber will be responsible for initiating a PA request.  For therapeutic drug classes that do not appear on the PDL, nothing has changed.

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MEDICAL HOME

The 4C team works in collaboration with primary care providers (PCP) to encourage enrollees to call their doctor first for treatment of non emergent illnesses and other conditions.  The PCP offers the best care for the patient and family because they know the patient’s clinical history.  When the patient is sick, the medical provider can determine if treatment at home, in the office or in the emergency department is required.  Many medical practices have a 24 hour nurse triage line available to answer questions and concerns after hours.  

The goal of the medical home and emergency department initiative is to increase awareness of the medical home concept for adults and children and decrease the inappropriate use of the emergency department resources through education, outreach and follow-up.

 

For more information about the Medical Home Concept, please visit the sites below or call 4C!

 

  Division of Medical Assistance (DMA)
  Cumberland County Department of Social Services
  NC Healthy Start Foundation
  Medical Home vs. Emergency Room
  Choosing a Quality Medical Home

 

Carolina Collaborative Community Care (4C)

Phone: (910) 485-1250 Fax: (910) 485-7238