Florida Medicaid Recipients Entitled to Notification of Reasons for Denial of Prescription Drug Coverage and Steps They Can Take to Appeal Denial

Hernandez v. Medows,  No. 02-20964-Civ-Gold/Simonton (S.D. Fla. order 5/21/03); 12(24) BNA's Health Law Reporter 925-26 (June 12, 2003)

Under a settlement agreement approved by a federal judge, Florida Medicaid recipients who are denied prescription drug coverage will be notified in writing of the reason for the rejection and what steps they can take to appeal the decision. In addition, the Florida agency responsible for these determinations, the Agency for Health Care Administration (AHCA), agreed to provide the services of an ombudsman office to assist in resolving claim reimbursement problems.  The agreement also provides for emergency coverage if a pharmacist believes failure to receive a drug could result in a serious health threatening situation.  In addition, the AHCA agreed to pay for brand name drugs if a physician asserts they are medically necessary...

Found in DMHL Volume 23 Issue 1