Refills are available if indicated on the member's original prescription. The refill too soon edit is applied to all plans. For most plans, the refill prescription is covered only after two-thirds of the member's prescription has already been used. For example, if the previous supply was a 30-day supply, a member may refill the prescription on the 20th day, but not earlier. For other plans, the criteria may differ based on an employer group's benefit design. The on-line claims processing system will deny the claim if the refill falls outside the refill too soon criteria.
|Rev#:||Date:||Nature of Change:|
|1.0||12/16/2009||Added information that effective January 1, 2010, there will also be a look back period of 90 days.|
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