Refill Utilization

A refill is considered too soon, or early, if the person has not used at least 75% of the previous fill of the medication.

Traditional Medicaid and CSHCN

A refill for certain controlled substances, such as tramadol, is considered too soon if the person has not used at least 90% of the previous fill of the medication. Attention deficit hyperactivity disorder drugs and certain seizure medications are excluded from this requirement.

Refer to the Formulary search, and select the "90% Utilization" filter to identify these drugs.

Claims not meeting the utilization threshold will reject with NCPDP error code "79".  A previous fill may have been from a different pharmacy.