We are a health plan attempting to define our course of action for pharmacy authorizations for non-formulary drugs. Must the 278 Health Care Review transaction be used for electronic authorizations from/to providers for authorization to prescribe non-formulary drugs?
It does not appear that the 278 transaction is designed for this purpose. While it might possibly be argued that this fits into the transaction's defined business purpose of "health care services certification," there does not seem to be any elements defined within the transaction to include the information that we currently require from the provider such as drug name, strength, dosing, quantity, length of therapy, and the reason for the request.
Has anyone else run into this question? What conclusion have you drawn?
Thank you for any help you can provide.
Ellen Tatge
IS Project Manager
Presbyterian Healthcare Services
505/923-6882
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