Delaware’s Department of Insurance urges health insurers and Pharmacy Benefit Managers to assist families affected by a school fire in Milford.
Last week, Insurance Commissioner Trinidad Navarro issued a bulletin calling for swift, flexible action to help families replace essential medications.
Navarro issued the bulletin after being notified by state education and health officials that the fire at Lulu Ross Elementary School destroyed medications that were kept on-site for students.
Navarro explains why the bulletin was sent out last week.
"We put out the bulletin to essentially notify the industry what has happened, and that we're seeking their cooperation so that those potential challenges won't be at the level that they may otherwise be," said Navarro.
Navarro notes families trying to get medication replacement could face obstacles like refill timing restrictions, prior authorization requirements or quantity limits.
"We're talking about children who need these medications, and so it was really the right thing to do when we found out that this was a problem," said Navarro. "We're basically asking all the entities involved in the prescription drug coverage arena to respond with urgency, flexibility and compassion. So families coping with the unexpected loss should not face unnecessary delays in obtaining medications their kids need."
The bulletin calls for expediting coverage determinations and claims processing, allowing early or out-of-cycle prescription refills when necessary and waiving or accelerating prior authorization requirements and quantity limits when appropriate.
The bulletin also communicates processing instructions to pharmacies, help desks and customer service representatives to ensure consistent handling of replacement medication requests.
It also calls for working collaboratively with pharmacies, health care providers, and families to prevent interruptions in treatment, and utilizing exception processes to quickly resolve issues involving replacement medications as well as exercising reasonable discretion and avoiding unnecessary documentation requirements that could delay access to care.
If families have any issues in replacing medications, Navarro says call the Delaware Department of Insurance at (302) 674-7300.
