Dispensing 72-hour Emergency Prescriptions

Federal and Texas law requires that a 72-hour emergency supply of a prescribed drug be provided when the medication is needed without delay and prior authorization is not available.  This rule applies to non-preferred drugs on the Preferred Drug List and any drug that is affected by a clinical PA edits that would need the prescriber’s prior approval. 

A 72-hour emergency supply of prescribed medication should be dispensed any time a prior authorization is not available and a prescription must be filled without delay for a medical condition. If the prescribing provider cannot be reached or is unable to request a prior authorization, the pharmacy should submit an emergency 72-hour prescription. This procedure should not be used for routine and continuous overrides. A 72-hour emergency prescription will be paid in full to pharmacy, and it does not count toward the three-prescription limit for adults who have not already received their maximum prescriptions for the month (there is no prescription limit for children under 21).

Pharmacies should submit the following information:

• "8" in "Prior Authorization Type Code" (Field 461-EU).
• "8Ø1" in "Prior Authorization Number Submitted" (Field 462-EV).
• "3" in "Days Supply" (in the Claim segment of the billing transaction) (Field 4Ø5-D5).
• The quantity submitted in "Quantity Dispensed" (Field 442-E7) should not exceed the quantity necessary for a three-day supply according to the directions for administration given by the prescriber. If the medication is a dosage form that prevents a three-day supply from being dispensed, e.g. an inhaler, it is still permissible to indicate that the emergency prescription is a three-day supply, and enter the full quantity dispensed.

We encourage you to post these instructions in your pharmacy for reference and to reproduce this information for staff education. It is very important that your staff understands the 72-hour emergency supply policy and procedures and uses them appropriately.

• Emergency Prescription override instructions
• Preferred Drug List
• Clinical Edits
• Pharmacy Education