Summary


After filing a proposed change to this rule near the end of 2012, the Department received comments from the Utah Office of Inspector General (OIG) that expressed concern over a provision which allowed members of the Restriction Program to make verbal requests to change their Pharmacy or Restriction Case Manager. OIG objected to this provision because it felt that only written requests are appropriate and necessary to create an audit trail to prevent overutilization of services and subsequent waste and abuse. Thus, to provide flexibility with tighter controls, OIG submitted its own proposed language to define emergency circumstances that would allow a Medicaid member to make a verbal request. This language, in effect, allowed a pharmacy to provide an emergency three-day supply of any prescription at any time as long as the member's verbal request met one of the criterion of a qualifying emergency as outlined in OIG's proposed language.