ARSD 67:16:14:06
Payment for items covered under this chapter and dispensed by a pharmacy is made at the lowest of the following:
(4) The payment limit established by the department, in consultation with the contractor, for drugs contained on the state MAC list, plus a dispensing fee contained on the department's fee schedule website.
For purposes of this section, the provider's usual and customary charge is that charge made by the provider to third-party payers for a specific item on the day the item is supplied.
Cross-References:
Upper limits for multiple-source drugs, 42 C.F.R. § 447.332.
Payment for drugs dispensed by physician, § 67:16:14:06.06.
Payment for drugs dispensed by PHS provider, § 67:16:14:06.09.
Federal drug list, http://www.cms.hhs.gov/home/medicaid.asp.
State MAC list, Department's pharmacy website.
Source: SL 1975, ch 16, § 1; 1 SDR 77, effective May 29, 1975; 4 SDR 10, effective August 28, 1977; 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 13 SDR 8, effective August 3, 1986; 14 SDR 153, effective May 23, 1988; 16 SDR 234, effective July 1, 1990; 17 SDR 200, effective July 1, 1991; 22 SDR 93, effective January 7, 1996; 29 SDR 113, effective February 13, 2003; 31 SDR 21, effective August 25, 2004; 37 SDR 236, effective June 28, 2011; 37 SDR 236, adopted June 8, 2011, effective July 1, 2012; 38 SDR 224, effective July 1, 2012; 40 SDR 15, effective July 31, 2013; 42 SDR 51, effective October 13, 2015.
General Authority: SDCL 28-6-1 , 28-6-1.1.
Law Implemented: SDCL 28-6-1 , 28-6-1.1.
Prior versions effective: 2013-07-31.