Pharmacy Lock-in Program

The Bureau of Pharmacy Services Recipient Lock-in Program may restrict a patient to a single pharmacy to obtain all of his or her Medicaid reimbursed prescriptions. The purpose of this program is to prevent duplicate and inappropriate drug therapies by providing coordination and oversight of the patient’s drug therapy.  Patients most likely to benefit from this service are those who see multiple physicians with complicated drug regimens. Also, patients suspected of "doctor shopping" could be restricted to one pharmacy for their Medicaid prescriptions.

If you believe a patient in your practice would benefit by being restricted to one pharmacy, please see below for a link to a referral form for this program. We will work with your patients to find a pharmacy that is acceptable to the Agency and convenient for your patient.

For recipients already restricted to one pharmacy and who are requesting to change to your pharmacy, please see below for a link to the form below.  All requests to change pharmacies are subject to approval by the Agency.

To use the form you need, please select the title of the form in the table below.  Please fax the completed form to (800) 332-1024.

Form Number Title (Effective June 2012)
MPDS2012-1-22 Recipient Lock-in Letter Form [13KB PDF]

MPDS2012-1-23

Request for Reconsideration Form [25KB PDF]
MPDS2012-1-24 Your Right to a Fair Hearing [16KB PDF]
MPDS2012-1-25 Request to Change Lock-in Pharmacy [56KB PDF]
MPDS2012-1-26 Recipient Pharmacy Lock-In Referral Form [67KB PDF]

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