Medication Therapy Management (MTM)
Download the Pharmacy Benefits Services the Medication Therapy Management (MTM) Form.
DC Prescription Drug Monitoring Program (PDMP)
The Prescription Drug Monitoring Program (PDMP) aims to improve the District’s ability to identify and reduce diversion of prescription drugs in an efficient and cost-effective manner that will not impede the appropriate medical utilization of controlled substances.
The Prescription Drug Monitoring Program Query Amendment Act of 2020 became effective on March 16, 2021. Following the passage of the law, DC prescribers and dispensers will be mandated to query the PDMP:
- prior to prescribing or dispensing an opioid or benzodiazepine for more than 7 consecutive days and
- every 90 days thereafter while the course of treatment or therapy continues, or
- prior to dispensing another refill after 90 days
A video recording of the recent Mandatory Query Amendment Act webinar is available at this link. View the recording to learn more about the requirements of the Act, how to perform a patient query, and other DC PDMP features. In addition, the DC PDMP Home Page contains other helpful resources for physicians, pharmacists, and other health care practitioners who utilize the PDMP.
HSCSN Formulary
As of March 16, 2020, the Health Services for Children with Special Needs (HSCSN) Formulary is effective. This formulary allows us to steer enrollees to effective, lower-cost medications.
New prescriptions
As of Monday, March 16, 2020, enrollees who are prescribed new medications may be told by the pharmacist that they need a prior authorization (PA) or a formulary exception (FE).
Transition of Care
HSCSN is allowing two Transition of Care fills (30 days x 2) to allow time for the enrollee and prescriber to work together to submit a PA or FE request. HSCSN has grandfathered many of the medications so that enrollees can stay on the medication without PA or FE for either one (1) year or lifetime, prescribers will be provided with details about grandfathered medications in the near future.
Emergency Fills
If a prescription is submitted to a pharmacy and requires PA or FE, the pharmacist can provide a 7-day supply to the enrollee by doing an override, if the pharmacist feels it is appropriate to the situation. This is called an Emergency Fill.
Pharmacy Prior Authorization
Providers can fax the Pharmacy Prior Authorization form to CVS Health at 1-888-836-0730 or call the CVS Utilization Management Department at (877) 433-7643.
Prior Authorization and Formulary Exception Form
CVS Caremark Mail Order Service
We encourage enrollees to use the CVS Caremark Mail Order Pharmacy. Below you will find the CVS Caremark Mail Order Fax Form. For additional information on Mail Order Services please contact CVS Health at (800) 875-0867. Forms can be faxed to: (800) 378-0323.
CVS Caremark Mail Order Fax Form
Specialty Medications
For specialty medications, HSCSN uses CVS Specialty Pharmacy. For more information on specialty medications please call CVS Health (800) 237-2767. Forms can be faxed to (800) 323-2445, or visit www.CVSspecialty.com.
