Attachment 2 - Override Procedures updated 6-21-2023.pdf

Attachment 2 – Override Procedures

Override Procedures

When a beneficiary is requesting an early fill, the pharmacy contacts the Pharmacy Benefits Manager

(PBM). Depending upon the circumstances and medication the PBM is authorized to give the override without contacting the Veteran Family Member Program (VFMP).

Overrides are given in certain circumstances such as:

• Stolen medications

• Vacation

• Lost medications

• School outside of network area (overseas)

• Long Term Care (LTC)

• Natural disasters

• Dose change

• Mail order delay

• Brand switch (allergy)

• Unbreakable packaging

If a beneficiary needs an early fill for the below type medications and circumstances, the PBM then contacts VFMP.

• Narcotics (only 3 overrides are given in a calendar year)

• Requests for more than 3 months (if a 90-day supply)

• Any situation the PBM deems necessary to contact the VFMP Veterans Health Administration

Office of Integrated Veteran Care (VHA IVC) team

The request needs to have the following information:

• Beneficiary name

• Social Security Number (SSN)

• Medication name

• Reason for override

Items that require an approval from VFMP prior to dispensing Nutritional Liquids

Requirements: Feeding tube, children with failure to thrive, PKU (phenylketonuria)

Pain Medications

Requirements: Certain pain medications are dual use for pain and opioid dependence

Botox

Requirements: Must follow policy guidelines

CHAPTER: 2

SECTION: 22.5

TITLE: BOTULINUM TOXIN INJECTIONS

Fertility Medications

Requirements: Must not be used in conjunction with any type of IVF/ART/IUI (artificial insemination)

Epidiolex

Requirements: Must meet Food and Drug Administration (FDA) requirement for specific seizure disorders

Sildenafil, Tadalafil (when prescribed for women)

Requirements: Must be for PAH (pulmonary arterial hypertension)

Attachment 2 - Override Procedures page 2