If a medication is on the Federal Upper Limit (FUL) list, what must be indicated on the prescription by the prescriber?

When a medication is identified on the Federal Upper Limit (FUL) list, it indicates that the drug has a maximum allowable reimbursement price set by the federal government, often influencing the cost of the medication under various healthcare plans. If a prescriber indicates "medically necessary" or uses equivalent language, it signifies that the prescriber believes there is an essential need for that specific medication, likely due to the patient's unique medical situation or potential efficacy issues with generic alternatives. This notation serves to communicate to pharmacists and insurance providers that the prescribed medication should be prioritized even if it exceeds the FUL, ensuring the patient receives optimal care in accordance with the prescriber's clinical judgment.

The other available options do not convey the same level of necessity for the specific medication. Stating "brand name preferred" might suggest an inclination towards a brand medication but does not account for the medical necessity of that choice, whereas "generic substitution allowed" indicates that generic options may be considered without any specific need for the brand. Finally, "therapeutic alternatives available" merely implies that there are other medications that could potentially be used instead but does not provide justification for the selected medication. Hence, indicating "medically necessary" or equivalent language is the most appropriate action when a medication appears