Provider Notice issued 06/30/12

Clotting Factor Dispensing August 1, 2012

To:​ Participating Pharmacies​
​Date: ​June 30, 2012
​Re:  Clotting Factor Dispensing August 1, 2012​

As a result of Public Act 097-0689 (pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, the department will develop a program of utilization management and control for patients with hemophilia who fill blood factor prescriptions, including requiring providers who dispense blood factor to meet certain standards. Effective August 1, 2012, in order to dispense blood factor to Medical Assistance participants, providers must have a signed Standards of Care Agreement (SOCA) on file with the department. Beginning with dates of service August 1, 2012, if the department receives a claim for blood factor from a provider who has not signed a SOCA, the claim will reject with the following rejection message: Standards of Care Agreement not on File.

The purpose of the SOCA is to ensure that providers who dispense blood factor dispense only that which is necessary to meet the patient’s needs, and provide quality services beyond the dispensing of blood factor.

The department is in the process of finalizing the SOCA. A copy of the SOCA, along with a letter of explanation, will be mailed to all providers who dispensed blood factor to Medical Assistance clients during Fiscal Year 2012, and will be made available on the department’s Web site.

Any questions regarding this notice should be directed to the Bureau of Pharmacy Services at 1-877-782-5565, option 7.

Theresa A. Eagleson, Administrator

Division of Medical Programs