If a customer urgently needs medication filled during LifeWise's non-business hours, the pharmacy can do a one-time override. To see if a medication qualifies for an emergency override, view our list of medication types eligible for up to a 7-day override.
This emergency override list is only applicable to customers who are enrolled in a Washington fully-insured group or individual health plan.
Customers who get an emergency fill may have to pay their cost share, which is the portion of healthcare costs the customer is responsible for, as determined by their plan. This may include deductibles, coinsurance, copayments, and similar charges.
The medication list for emergency fill to address immediate therapeutic needs is as follows: (Medications in addition to those listed may be covered for Emergency Fill on a health plan by health plan basis).
High dollar medications for chronic conditions, such as oral oncology, hepatitis C, biologics, multiple sclerosis treatments, enzyme replacements, and so on are not consistent with the above definition of “immediate therapeutic needs” and thus would not be covered for emergency fill.
Also, an emergency fill will not be paid in the following situations:
Emergency Fills are appropriate in those circumstances where a patient presents at a pharmacy with an 'immediate therapeutic need' for a prescribed medication that requires a pre-authorization due to formulary or other utilization management restrictions.
The dosage of the Emergency Fill must either be the minimum packaging size that cannot be broken (e.g. injectable), or the lesser of a 7-day supply or the amount as prescribed. (Depending upon their policies, Health Plans may exceed this baseline dispensing amount.) In the event the medication is to be continued for treatment beyond the emergency fill authorization, health plans may apply formulary or utilization management restrictions that will be reviewed following the health plans' standard procedure.
When a currently eligible member of the health presents at a contracted dispensing pharmacy with an immediate therapeutic need and a corresponding prescription from their provider for a medication requiring a pre-authorization that is specified on the list,
The health plan's Emergency Fill policy (which must be on their web site) will outline their process by which the dispensing pharmacy can secure payment for emergency fill. Two typical processes are:
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