2702.1 Medicaid reimbursement of covered outpatient drugs to fee for service pharmacies shall include a professional dispensing fee. A professional dispensing fee is a fee that:

(a) Is incurred at the point of sale or service;

(b) Pays for pharmacy costs in excess of the ingredient cost of a covered outpatient drug each time a covered outpatient drug is dispensed;

(c) Includes only pharmacy costs associated with ensuring that possession of the appropriate covered outpatient drug is transferred to a Medicaid beneficiary. Pharmacy costs include, but are not limited to reasonable costs associated with delivery, special packaging and overhead associated with maintaining the facility and equipment necessary to operate the pharmacy, and a pharmacist's time spent:

(1) Checking the computer for information about an individual's coverage

(2) Performing drug utilization review and preferred drug list review activities;

(3) Measuring or mixing of the covered outpatient drug;

(4) Filling the container;

(5) Counseling a beneficiary; and

(6) Physically providing the completed prescription to the Medicaid beneficiary.

2702.2 The professional dispensing fee shall not include administrative costs incurred by the District in the operation of the covered outpatient drug benefit including systems costs for interfacing with pharmacies.

SOURCE: Final Rulemaking published at 59 DCR 2298, 2300 (March 23, 2012); as amended by Final Rulemaking published at 65 DCR 7837 (July 27, 2018).