Payment for items covered under this chapter and dispensed by a physician or other licensed practitioner is made according to one of the following:

1. (1) If a pharmacy is not available in the provider's service area, payment is made according to § 67:16:14:06;
2. (2) If a pharmacy is available in the provider's service area, payment is limited to the provider's cost of the item; or

3. (3) If the physician is a PHS provider and the drug being dispensed is covered under the PHS program, payment is made according to § 67:16:14:06.09.

   If submitting a claim for services provided under subdivision (2) or (3) of this section, the physician or other licensed practitioner must maintain a copy of the supplier's invoice showing the actual cost of the item to the provider. At the department's request, the provider must furnish a copy of the invoice to substantiate the claim.

Source: Transferred from § 67:16:14:06; 14 SDR 153, effective May 23, 1988; 16 SDR 234, effective July 1, 1990; 22 SDR 93, effective January 7, 1996; 44 SDR 94, effective December 4, 2017.

General Authority: SDCL 28-6-1 (1)(2) .

Law Implemented: SDCL 28-6-1 (1)(2) .

Prior versions effective: 1996-01-07.