PURPOSE: The Division of Medical Services establishes that when a pharmacy dispenses drugs in a controlled-dose delivery system, the pharmacy must give the Division of Medical Services credit for any unused portion of the drug that is reusable in accordance with applicable federal or state law.

1. (1) Definitions.

   1. (A) Controlled-dose delivery system. A controlled-dose delivery system is defined as a system of dispensing of medications on behalf of a resident in a long-term care facility in manufacturer’s unit dose packaging or pharmacist packager’s unit dose, unit-of-use, or strip packaging with each tablet or capsule 13 CSR 70-20

individually wrapped, or in blister cards, all of which must be dispensed according to applicable state and federal laws or regulations.

1. (2) Drugs dispensed in controlled-dose delivery system packaging and other drug products which may be returned for reuse per federal and state laws or regulations shall be returned to the dispensing pharmacy in accordance with federal or state laws or regulations when the recipient no longer uses the drug and that product, in the pharmacist’s professional judgement may be reused.
2. (3) The Division of Medical Services shall not pay for an unused pharmacy item returned to the dispensing pharmacy by or on behalf of a Medicaid recipient, due to a change in prescription, hospitalization, death of a recipient, or other reason when the item can be accepted for reuse by the pharmacy in accordance with applicable federal or state laws or regulations.
3. (4) When a pharmacy dispenses drugs in a controlled-dose delivery system the pharmacy must give the Division of Medical Services credit for all reusable items (any unused portion) not taken by the Medicaid recipient. The Division of Medical Services may provide additional compensation to the pharmacy to recognize administrative costs for processing reusable returned drugs, subject to appropriation. In instances in which charges have been submitted prior to the return of an item the pharmacy shall file an adjustment to notify the Division of Medical Services of the need to process a credit. The dispensing pharmacy that receives the returned drugs must provide a credit to the Division of Medical Services for the amount reimbursed for drug costs from which the prescription was billed, prorated to the quantity of the drug returned. The credited amount should not include dispensing fees.

AUTHORITY: section 208.201, RSMo 2000.* Original rule filed Dec. 15, 2000, effective July 30, 2001. *Original authority: 208.201, RSMo 1987.