North Carolina News: Item 2121 - Medicare Part D Plans and NTI Drugs

July 1, 2006 3:19 pm Topics: Narrow therapeutic index

Reprinted from the July 2006 North Carolina Board of Pharmacy Newsletter.

The Board has received several complaints that Medicare Part D payors are refusing to reimburse pharmacists for dispensing one particular generic version of a Narrow Therapeutic Index (NTI) drug versus another plan-preferred generic version of an NTI drug. Under North Carolina law (NCGS §90-85.28(b1)), a “prescription for an [NTI] drug shall be refilled using only the same drug product by the same manufacturer that the pharmacist law dispensed under the prescription, unless the prescriber is notified by the pharmacist prior to the dispensing of another manufacturer’s product, and the prescriber and the patient give documented consent to the dispensing of the other manufacturer’s product.” Drugs currently on the NTI list are: carbamazepine, cyclosporine, digoxin, ethosuximide, levothyroxine sodium tablets, lithium, phenytoin, procainamide, theophylline, and warfarin.

Pharmacists should advise payors of these limitations on substituting NTI drugs and should resist being forced to make a substitution that would violate state law. If a payor refuses to adjust their expectations, please advise Board staff.