In instances in which prior authorization (PA) cannot be immediately obtained, a pharmacist may dispense and be reimbursed for up to a 72-hour supply of a covered outpatient drug as an “emergency supply”.

In addition, in order to allow for holiday weekends and times when prior authorization offices are closed, operational policy regarding "emergency supply" is that pharmacies can be paid for claims representing a maximum of a four day supply of a covered outpatient drug, without prior authorization. For packaging that inherently cannot be broken down to a four day or less supply (example: metered dose inhalers), the pharmacy should dispense the smallest quantity possible that is adequate for the "emergency supply". The provider should internally document that the quantity dispensed was, due to manufacturer packaging constraints, the least that could be dispensed while meeting the patient needs for the “emergency supply”.

All “emergency supply” claims (both paper and electronic/POS) should be submitted with the Level of Service = 03 (“Emergency” Indicator) and the actual "days supply" being dispensed, up to but not exceeding "4".