Office of Health Care Reform


December 9, 2005


In consultation with the various state agencies responsible for the administration of pharmacy benefits, the Governor’s Office of Health Care Reform has reviewed the results of recent pharmacy audits. Based on a review of the audits findings, the Office of Health Care Reform and the affected agencies, after consultation with the State Board of Pharmacy, and the State Board of Medicine, have reached the following policy decisions:


Prior to November 30, 2005, undated non-controlled prescriptions will not be questioned.  However, EFFECTIVE JANUARY 2, 2006, CLAIMS WILL BE DISALLOWED on audit, at the Agency’s discretion, if:



Stamped dates, dates on prescription faxes and electronically transmitted prescription dates are all acceptable.


Letters from the physician’s office obtained after the audit has been conducted or copies of dated pharmacy computer labels will not be accepted as proof of the date the prescription was written.


  Also, Providers are reminded that claims will be disallowed on audit if: