Dear Colleague,

This notice has important information regarding early prescription medication refills for persons with intellectual and developmental disabilities (I/DD) who have Medicaid, and also for those are dually eligible for both Medicare and Medicaid. For persons with I/DD who also have private health insurance (and who receive prescription medications through that insurance), contact should be made with that health insurer regarding their policy on early prescription refills.

Information from NJ Medicaid:
Please see the attachment below from NJ Medicaid, alerting physicians, advance practice nurses and pharmaceutical services in New Jersey about helpful changes in dispensing of prescription medications for Medicaid beneficiaries.
  • Dispensing of a 90-day supply of maintenance medications is permitted.
  • Early prescription refills are permitted.

Information from the Centers for Medicare and Medicaid Services (CMS):
CMS has outlined the flexibilities that Medicare Part D and Medicare Advantage plans have to waive certain requirements to help prevent the spread of COVID-19. These flexibilities include:
  • Waiving cost-sharing for COVID-19 tests
  • Waiving cost-sharing for COVID-19 treatments in doctor’s offices or emergency rooms and services delivered via telehealth
  • Removing prior authorization requirements
  • Waiving prescription refill limits
  • Relaxing restrictions on home or mail delivery of prescription drugs
  • Expanding access to certain telehealth services
Please note that with regard to prescription medication refills, the CMS guidance does not give a specific time frame:
“Relax “Refill-Too-Soon” Edits and Provide Maximum Extended Day Supply
Part D sponsors may relax their “refill-too-soon” edits if circumstances are reasonably expected to result in a disruption in access to drugs. Sponsors have operational discretion as to how these edits are relaxed as long as access to Part D drugs is provided at the point-of-sale. Part D sponsors may also allow an affected enrollee to obtain the maximum extended day supply available under their plan, if requested and available.”
Caregivers of individuals who are dually eligible for Medicare and Medicaid, and who want to obtain early prescription medication refills should first check with the pharmacist to find out if that is permitted from their Part D drug plan.  If the pharmacist is not able to provide the answer (or if the answer is "no"), you may want to contact the Part D drug plan directly.
Please share this with others who may also be interested.

Thank you.


Beverly Roberts
Director, Mainstreaming Medical Care
The Arc of New Jersey
985 Livingston Avenue
North Brunswick, NJ 08902