Wyo. Code R. 048-0037-10
Medicaid
Chapter 10: Medical Pharmaceutical Services
Effective Date: 12/16/1998 to 05/15/2001
Rule Type: Superceded Rules & Regulations
Reference Number: 048.0037.10.12161998
This Chapter is promulgated by the Department of Health pursuant to the Medical Assistance and Services Act at W. S. 42-4-101 et seq. and the Wyoming Administrative Procedures Act at W. S. 16-3-101 et seq.
(a) This Chapter establishes the standards and procedures for the provision of and payment for pharmaceutical services under Medicaid. It shall apply to all pharmaceutical services provided on or after January 1, 1999.
(b) The Division may issue Provider Manuals, Provider Bulletins, or both, to interpret the provisions of this Chapter. Such Provider Manuals and Provider Bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in Provider Manuals or Provider bulletins shall be subordinate to the provisions of this Chapter.
Except as otherwise specified, the terminology used in this Chapter is the standard terminology and has the standard meaning used in health care, Medicaid, and Medicare.
(a) 'Abuse.' 'Abuse' as defined in Chapter 16, which definition is incorporated by this reference.
(b) 'Average wholesale price' or 'AWP.' The average wholesale price as computed by First Data Bank, which is hereby incorporated by reference.
(c) 'Board of Pharmacy.' The Wyoming State Board of Pharmacy, its agent, designee or successor.
(d) 'Board of Pharmacy Chapter 9.' Chapter 9, Patient Counseling and Drug Use Review Regulations, of the Wyoming State Board of Pharmacy Rules.
(e) 'Brand name.' The proprietary or trade name selected by the manufacturer and placed upon a drug, its container, label or wrapping at the time of packaging.
(f) 'Chapter 1.' Chapter 1, Rules for Medicaid Administrative Hearings, of the Wyoming Medicaid Rules.
(g) 'Chapter 3.' Chapter 3, Provider Participation, of the Wyoming Medicaid Rules.
(h) 'Chapter 4.' Chapter 4, Third Party Liability, of the Wyoming Medicaid Rules.
(i) 'Chapter 6.' Chapter 6, Health Check (formerly EPSDT), of the Wyoming Medicaid Rules.
(j) 'Chapter 7.' Chapter 7, Wyoming Nursing Home Reimbursement System, of the Wyoming Medicaid Rules.
(k) 'Chapter 9.' Chapter 9, Hospital Services, of the Wyoming Medicaid Rules.
(l) 'Chapter 16.' Chapter 16, Medicaid Program Integrity, of the Wyoming Medicaid Rules.
(m) 'Chapter 26.' Chapter 26, Covered Services, of the Wyoming Medicaid Rules.
(n) 'Chapter 39.' Chapter 39, Recovery of Excess Payments, of the Wyoming Medicaid Rules.
(o) 'Claim.' A request by a provider for Medicaid payment for services provided to a recipient.
(p) 'Compound drug.' A mixture of two or more ingredients to form a drug.
(q) 'Copayment.' The charge to a recipient seeking pharmaceutical services.
(r) 'Covered services.' Services which are Medicaid reimbursable pursuant to the rules of the Department.
(s) 'Department.' The Wyoming Department of Health, its agent, designee or successor.
(t) 'Device.' Equipment or apparatus used to remedy or compensate for a physical deficiency, e.g., a prosthetic device.
(u) 'Dispensing fee.' The amount of Medicaid reimbursement allowed by the Division as payment for the service of dispensing a prescribed drug.
(v) 'Division.' The Division of Health Care Financing of the Department, its agent, designee or successor.
(w) 'DUR requirements.' The Drug Utilization and Review requirements as set forth in Board of Pharmacy Chapter 9, which requirements are incorporated by this reference.
(x) 'Drug.'
(i) Substances recognized as drugs in official United States Pharmacopoeia, official Homeopathic Pharmacopoeia of the United States, or official National Formulary, or any supplement to any of them, all of which are incorporated by this reference;
(ii) Substances intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in a person;
(iii) Substances (other than food) intended to affect the structure or any function of a person's body; or
(iv) Substances intended for use as a component of any article specified in (i) through (iii).
(y) 'Drug Efficacy Study Implementation (DESI) drugs.' Drugs determined by the United States Food and Drug Administration to be less than effective. This definition applies to all drugs which are similar, related, or identical to DESI drugs pursuant to FDA designation. Compound formulations which contain a DESI drug are considered to be DESI drugs.
(z) 'Elderly and physically disabled waiver services.' Services provided to elderly and/or physically disabled persons pursuant to section 1915(c) of the Social Security Act (codified at 42 U.S.C. § 1396n).
(aa) 'Emergency.' The sudden onset of a medical condition, including labor and delivery, manifesting itself by acute symptoms of sufficient severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in:
(i) Placing the patient's health in serious jeopardy;
(ii) Serious impairment of bodily functions; or
(iii) Serious dysfunction of any bodily organ or part.
(bb) 'Estimated acquisition cost' or 'EAC.' AWP minus eleven percent (11%).
(cc) 'Excess payment.' 'Excess payment' as defined in Chapter 39, which definition is incorporated by this reference.
(dd) 'FDA.' The Food and Drug Administration of the United States of America.
(ee) 'Fixed component of the fee.' The cost to dispense as determined pursuant to Section 14. Until redetermined pursuant to that Section, the fixed fee is $4.70.
(ff) 'Formulary.' A compilation, by the Division, of therapeutically effective drugs and medical supplies deemed appropriate by the Division for inclusion in the formulary. The formulary may be changed from time to time.
(i) New or different legend drugs will automatically be added to the formulary if:
(A) There is a rebate agreement in effect which meets the requirements of Pub. L. No. 101-508, Section 4401(a) including any amendments or updates; and
(B) The drug is not within a class of drugs which is not a covered service.
(ii) OTC drugs may be added to the formulary if they become covered services pursuant to subsection 9(f);
(iii) Medical supplies may be added to the formulary if they become covered services pursuant to subsection 9(h).
(iv) The Division shall distribute to providers a list of drugs and medical supplies which are excluded services. That list shall be distributed through Provider Manuals and/or Provider Bulletins, and shall be updated as necessary. Drugs and/or medical supplies which are not designated as excluded services shall be covered services.
(gg) 'Fraud.' 'Fraud' as defined in Chapter 16, which definition is incorporated by this reference.
(hh) 'HCFA.' The Health Care Financing Administration of the United States Department of Health and Human Services.
(ii) 'Hospital.' 'Hospital' as defined by Chapter 9, which definition is incorporated by this reference.
(jj) 'Legend drug.' A drug that is required by Federal law to be dispensed pursuant to a prescription.
(kk) 'Local trade area.' The geographic area surrounding the recipient's residence, including portions of states other than Wyoming, commonly used by other persons in the same area to obtain pharmaceutical services.
(ll) 'Maintenance drug.' Drugs furnished to an individual with a chronic illness or condition. The Division shall, from time to time, designate drugs as maintenance drugs based on therapeutic value, clinical consultation with practitioners, and applicable HCFA guidelines. The Division shall disseminate a current list of maintenance drugs which are covered services to providers through Provider Manuals or Provider Bulletins.
(mm) 'Medicaid.' Medical assistance and services provided pursuant to Title XIX of the Social Security Act and/or the Wyoming Medical Assistance and Services Act. 'Medicaid' includes any successor or replacement program enacted by Congress or the Wyoming Legislature.
(nn) 'Medicaid allowable payment.' The maximum Medicaid reimbursement for covered services as specified by this Chapter.
(oo) 'Medicaid Fraud Control Unit (MFCU).' The Medicaid Fraud Control Unit of the Wyoming Attorney General's Office, its agent, designee, or successor.
(pp) 'Medically necessary.' A pharmaceutical service that is:
(i) Consistent with the recipient's diagnosis or condition;
(ii) Recognized as the prevailing standard or current practice among the provider's peer group;
(iii) Rendered in response to a life-threatening condition or pain; to treat an injury, illness or infection; to treat a condition that could result in physical or mental disability; to care for a mother and child through the maternity period; or to achieve a level of physical or mental function which is consistent with prevailing community standards; or is a preventive pharmaceutical service.
(qq) 'Medical supplies.' Disposable, semi-disposable or expendable medical supplies. 'Medical supplies' does not include durable medical equipment, oxygen or oxygen supplies.
(rr) 'Medicare.' The health insurance program for the aged and disabled under Title XVIII of the Social Security Act.
(ss) 'Medicare cross-over claim.' A claim seeking reimbursement for a pharmaceutical service provided to a person who is eligible for Medicaid and Medicare.
(tt) 'MMP rule.' Chapter 1, Minimum Medical Program, of the Department's rules.
(uu) 'Multiple source drug.' A drug marketed or sold by two or more manufacturers or labelers or a drug marketed or sold by the same manufacturer or labeler under two or more different proprietary names.
(vv) 'National drug code' or 'NDC.' The code number determined for and assigned to a drug by the FDA.
(ww) 'Nursing facility.' 'Nursing facility' as defined in Chapter 7, which definition is incorporated by this reference.
(xx) 'Nursing facility services.' 'Nursing facility services' as defined in Chapter 7, which definition is incorporated by this reference.
(yy) 'One month supply.' The lesser of the quantity of drugs sufficient to last for thirty-four (34) days or 100 doses.
(zz) 'Overpayments.' 'Overpayments' as defined in Chapter 39, which definition is incorporated by this reference.
(aaa) 'Over-the counter (OTC) drugs.' Drugs which are legally available without a prescription.
(bbb) Pharmaceutical service.' Drugs, devices or medical supplies that are covered services.
(ccc) 'Pharmacist.' A person licensed to practice pharmacy by the Wyoming State Board of Pharmacy or a similar board or agency in another state.
(ddd) 'Pharmacy.' An entity licensed to operate a pharmacy by the Wyoming State Board of Pharmacy or a similar board or agency in another state.
(eee) 'Physician.' A person licensed to practice medicine or osteopathy by the Wyoming State Board of Medical Examiners or a similar board or agency in another state.
(fff) 'Practitioner.' A physician or other licensed practitioner of the healing arts authorized to prescribe drugs and practicing within the scope of professional practice as defined under Wyoming Statutes or the laws of another state.
(ggg) 'Prescription.' A written, faxed, or oral order, as required by the Board of Pharmacy, from a practitioner that a certain drug, medical supply, device or service is medically necessary.
(hhh) 'Prescription drug.' A drug, including a legend drug, or medical supply that is:
(i) Prescribed by a practitioner acting within the scope of his practice; and
(ii) Dispensed by a provider pursuant to a written prescription that is recorded and maintained in the provider's records.
(iii) 'Provider.' A pharmacy, pharmacist or physician that is:
(i) Located in the State of Wyoming and has signed a provider agreement; or
(ii) Located outside the State of Wyoming, and
(A) Within the local trade area and has signed a provider agreement;
(B) Provides pharmaceutical services to a recipient:
(I) As the result of an emergency which occurs while the recipient is outside the State of Wyoming; or
(II) Who is less than 19 years of age; and:
(a) Is a foster child not covered by Title IV-E of the Social Security Act and resides with a foster family outside the State of Wyoming; or (b) Has been placed in an out-of-state institution.
(jjj) 'Provider Agreement.' A provider agreement as defined by Chapter 3, which definition is incorporated by this reference.
(kkk) 'Recipient.' A person who has been determined eligible for Medicaid.
(lll) 'Recipient age twenty-one or over.' A recipient after the month in which he or she turns twenty-one years of age.
(mmm) 'Recipient under age twenty-one.' A recipient before or during the month in which he or she turns twenty-one years of age.
(nnn) 'Residence.' The place a recipient uses as his or her primary dwelling place, and intends to continue to use indefinitely for that purpose.
(ooo) 'Service limitations.' 'Service limitations' as defined by the MMP rule, which definition is incorporated by this reference.
(ppp) 'Services.' Drugs, medical supplies and devices that are reimbursable pursuant to this Chapter.
(qqq) 'Services and supplies included in the per diem rate.' 'Services and supplies included in the per diem rate' as defined in Chapter 7, which definition is incorporated by this reference.
(rrr) 'Swingbed.' A bed in a hospital which is certified for either inpatient hospital services or nursing facility services.
(sss) 'TPL waiver.' A waiver granted by HCFA of the third party liability requirements of Chapter 4.
(ttt) 'Usual and customary.' The provider's charge to the general public for the same or similar services.
(uuu) 'Usual and customary prescription drug survey.' A survey of the selling prices charged by pharmacists for non-Medicaid prescriptions filled on a specific date. The survey is used to determine average cost plus profit (or fee) for all participating pharmacy providers. In conducting the survey, the Division may use such methods and request such information as it deems necessary.
(vvv) 'Variable component of the fee.' The portion of the dispensing fee based on the cost of a drug's ingredients as determined pursuant to Section 14. Until redetermined pursuant to that Section, the variable fee is .07 times AWP, except that the variable fee for multiple source drugs shall be .07 times the cost of the drug as determined pursuant to Section 14.
(a) Compliance with Chapter 3. An individual or entity that wishes to receive Medicaid funds for pharmaceutical services furnished to a recipient must meet the requirements of Chapter 3, which requirements are incorporated by this reference.
(b) Eligible pharmaceutical services providers.
(i) Pharmacies;
(ii) Pharmacists; and
(iii) Physicians who practice in a local trade area where pharmacy services are not available from a pharmacy or pharmacist may enroll as a Medicaid pharmacy services provider. Except as otherwise specified in this Chapter, such a physician must meet the standards and follow the procedures established for a pharmacist provider.
(a) Compliance with Chapter 3. A provider of pharmaceutical services must comply with the record-keeping requirements of Chapter 3, which are incorporated by this reference.
(b) Additional requirements. In addition to the requirements of Chapter 3, providers of pharmaceutical services must retain records that include:
(i) Invoices for drugs;
(ii) Prescriptions. All prescriptions must be reduced to writing. Prescriptions for brand name drugs must contain the certification 'medically necessary,' in the prescribing practitioner's hand-writing, and must be received and on file within thirty days after the oral prescription;
(iii) A signature log in the form specified by the Division;
(iv) Recipient account records; and
(v) Copies of claim forms.
Section 7. Verification of recipient data. A provider of pharmaceutical services must comply with the verification of recipient data requirements of Chapter 3, which are incorporated by this reference.
Section 8. DUR requirements. A provider of pharmaceutical services must comply with the DUR requirements as set forth in Board of Pharmacy Chapter 9.
(a) Prescription drugs. Prescription drugs included in the formulary are covered in the quantity prescribed by a practitioner, subject to the dispensing limitations of Section 10 and the exclusions of Section 12.
(b) Refill of prescription. In addition to the criteria specified in subsection (a), a refill of a prescription must:
(i) Be authorized by the practitioner who originally prescribed the drug; and
(ii) Such authorization must conform to State and Federal laws governing prescription refills.
(c) Brand name drugs certified in writing as medically necessary by the prescribing practitioner.
(d) Compound drugs if the main active ingredient is a prescription drug covered pursuant to subsection (a), and no ingredient of the compound is classified by the FDA as a DESI drug.
(e) OTC drugs and medical supplies. The OTC drugs specified in subsection (f) and the medical supplies specified in subsection (g) are covered services if:
(i) Furnished to a recipient who is not a resident of a nursing facility or occupying a swunged;
(ii) Prescribed by a practitioner;
(iii) Dispensed in the original trade package; and
(iv) The drug has been assigned an NDC number.
(f) Covered OTC drugs and products. OTC drugs or products as designated by the Division. The Division shall, from time to time, designate OTC drugs as covered services based on their therapeutic value, clinical consultation with practitioners and applicable HCFA guidelines. The Division shall disseminate a current list of OTC drugs which are covered services to providers through Provider Manuals or Provider Bulletins.
(g) OTC drugs not designated by the Division pursuant to subsection (f) are covered services if:
(i) Medically necessary; and
(ii) They serve as alternatives to more expensive drugs or therapy.
(iii) Procedure for requesting coverage of OTC drugs not covered pursuant to subsection (f). A practitioner, or a pharmacist on behalf of a practitioner, may request that an OTC drug not covered pursuant to subsection (f) be considered for coverage. Such request shall be directed to the Division and shall be in the form and contain the information specified by the Division. The Division may limit coverage to specified recipients for a specified period of time, or the Division may add the OTC drug to the formulary.
(h) Medical supplies which have been:
(i) Assigned an NDC;
(ii) Prescribed by a practitioner; and
(iii) Designated as covered medical supplies by the Division.
(A) The Division shall, from time to time, designate medical supplies as covered services based on their therapeutic value, clinical consultation with practitioners and applicable HCFA guidelines.
(B) The Division shall disseminate a current list of medical supplies which are covered services to providers through Provider Manuals or Provider Bulletins.
(a) Generic drugs. Practitioners are encouraged to prescribe generic drugs except when name brand drugs are medically necessary.
(b) Quantities dispensed.
(i) Maintenance drugs.
(A) Minimum quantities. Except as provided in subparagraph (C) maintenance drugs shall be dispensed in a quantity sufficient for at least a one month supply.
(B) Maximum quantities. Maintenance drugs shall not be dispensed in an amount which exceeds a ninety (90) day supply.
(C) Less than a one month supply of a maintenance drug may be dispensed to allow a recipient to be stabilized on a new or adjusted maintenance drug.
(ii) Oral contraceptives. The maximum quantity of oral contraceptive which may be dispensed is a three month supply.
(iii) All other drugs. The maximum quantity dispensed for all other conditions shall be a one-month supply.
(a) This Chapter does not affect the service limitations or copay requirement of the MMP rule.
(b) This Chapter does not limit the services available to recipients under age twenty-one pursuant to Chapter 6.
(a) The following prescription drugs are excluded:
(i) Anorexiants, except Amphetamines and derivatives which are prescribed for narcolepsy and hyperkinetic conditions;
(ii) Fertility drugs;
(iii) Hair growth products;
(iv) Weight gain agents, including androgenic or anabolic steroid agents when used for weight gain;
(v) Retin-A provided to recipients age twenty-one or over; and
(vi) Products containing nicotine and used for smoking cessation.
(b) OTC drugs and medical supplies as designated in Section 9(f).
(c) DESI drugs or compound drugs which contain a DESI drug.
(d) Drugs supplied by a manufacturer that has not entered into and does not have in effect a rebate agreement which meets the requirements of Pub. L. No. 101-508, Section 4401(a), including any amendments or updates, except as otherwise specified by that Section. Pub. L. No. 101-508, Section 4401(a) is hereby incorporated by this reference.
(e) Any services and supplies included in the per diem which are furnished to a resident of a nursing home or an individual in a swingbed, are not separately reimbursable pursuant to this Chapter.
(a) Recipients must pay a $2.00 per prescription copayment for pharmaceutical services, except as specified in subsection (b).
(b) This does not affect the copayment requirements of the MMP rule.
(c) Exemptions. The following recipients and pharmaceutical services are exempt from the copayment requirement:
(i) Residents of a nursing facility or in swingbeds;
(ii) Family planning products;
(iii) Pharmaceutical services related to pregnancy;
(iv) Pharmaceutical services provided to a recipient under age twenty-one; and
(v) Recipients of elderly and physically disabled waiver services.
(d) Notification of copayment amount. The Division shall notify providers of the copayment amount by means of a provider bulletin or as part of the provider manual. The Division shall notify recipients by bulletin.
(e) Collection of copayment. Providers are responsible for collecting the copayment. The amount of the copayment shall be automatically deducted by the Division from the Medicaid allowable payment, regardless of whether the copayment is actually paid.
(i) Prohibition or denial of services. A provider may not deny pharmaceutical services to a recipient because of the recipient's inability to make the copayment.
(ii) Regular refusal to make copayment. A provider may refuse pharmaceutical services to a recipient who regularly refuses to make copayments.
(a) Reimbursement Limits. Except as otherwise specified in this section, the Medicaid allowable payment for pharmaceutical services shall be the lower of:
(i) The estimated acquisition cost of the ingredient(s) plus the dispensing fee specified in subsection (d); or
(ii) The provider's usual and customary charge.
(b) Multiple source drugs. The Medicaid allowable payment for multiple source drugs shall be the lower of:
(i) The cost of the drug as determined pursuant to 42 C.F.R. 447.331-332, which regulations are hereby incorporated by reference, plus the dispensing fee specified in subsection (d); or
(ii) The provider's usual and customary charge.
(c) OTC drugs and medical supplies. The Medicaid allowable payment for prescribed OTC drugs and medical supplies shall be the lower of:
(i) 150% of the average wholesale price; or
(ii) The provider's usual and customary charge.
(d) Dispensing fee. Except as specified below, the dispensing fee shall be the lower of the provider's usual and customary dispensing fee or the sum of the fixed component of the fee plus the variable component of the fee. The dispensing fee shall be adjusted as specified in subsection (e).
(i) Physicians. The dispensing fee for physicians who dispense pharmacy services shall be $2.00 per prescription.
(e) Adjustment of dispensing fee. The dispensing fee shall be adjusted pursuant to (f) when necessary to:
(i) Enlist enough providers so that pharmaceutical services are available to recipients to the extent that those services are available to the general population; and
(ii) Ensure that payments are consistent with efficiency, economy and quality of care.
(f) Method of adjusting dispensing fee. The dispensing fee shall be adjusted as follows:
(i) The Division shall conduct a usual and customary survey;
(ii) Using the data collected pursuant to paragraph (i), the Division shall redetermine the fee.
(iii) The Division may use an appropriate indicator of pharmacy costs to adjust the dispensing fee.
(iv) The Division shall notify providers of any adjustment in the dispensing fee through a Provider Manual or Provider Bulletin.
(g) Prescription splitting. If a provider does not have sufficient supplies of a drug to fill a prescription completely, the provider may fill the prescription to the extent possible and claim a dispensing fee. When the balance of the prescription is dispensed, the provider may not seek an additional dispensing fee.
(h) Proof of delivery. A Provider must maintain a signature log, in the form specified by the Division, to act as proof of delivery of prescription drugs. Each recipient, or an individual acting on behalf of the recipient, must sign the log each time a prescription drug is delivered. For prescription drugs delivered to a nursing facility, the individual charged with ensuring the security of pharmaceutical supplies may sign the log after verifying delivery of all prescription drugs.
(a) Except as otherwise specified in this Chapter, submission and payment of claims shall be pursuant to the provisions of Chapter 3, which are incorporated by this reference.
(b) Medicaid is the payer of last resort unless otherwise specified in a HCFA TPL waiver for pharmaceutical services.
(a) The Division may recover excess payments pursuant to Chapter 39, which is incorporated by this reference.
(b) The Division may recover overpayments pursuant to Chapter 16, which is incorporated by this reference.
(a) The Division or HCFA may audit a provider at any time to determine whether the provider has received excess payments or overpayments.
(b) The Division or HCFA may perform audits through employees, agents, or through a third party. Audits shall be performed in accordance with generally accepted auditing standards.
(c) Disallowances. The Division shall recover excess payments or overpayments pursuant to Section 16.
(d) Reporting audit results. If at anytime during a financial audit or a medical audit, the Division discovers evidence suggesting fraud or abuse by a provider, that evidence, in addition to the Division's final audit report regarding that provider, shall be referred to the MFCU.
Section 18. Reconsideration. A provider may request that the Division reconsider a decision to recover excess payments or overpayments. The request for reconsideration, the reconsideration, and any administrative hearing shall be pursuant to the reconsideration provisions of Chapter 3, which are incorporated by this reference.
Section 19. Disposition of recovered funds. The Division shall dispose of recovered funds pursuant to the provisions of Chapter 16, which provisions are incorporated by this reference.
(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.
(b) The text of this Chapter shall control the titles of its various provisions.
Section 21. Superseding effect. This Chapter supersedes all prior rules or policy statements issued by the Department, including Provider Manuals and Provider Bulletins, which are inconsistent with this Chapter.
Section 22. Severability. If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.
The Wyoming Department of Health (the Department) is the single state agency appointed pursuant to the Social Security Act (the Act) to administer the Medicaid program in Wyoming. The Wyoming Medical Assistance and Services Act of 1967 (the Wyoming Act) requires the Department to administer the Medicaid program in conformance with federal standards.
The Wyoming Act authorizes the Department to promulgate necessary rules. The Wyoming Administrative Procedure Act requires all agency statements of general applicability that implement, interpret or prescribe law or policy be promulgated as rules.
The Health Care Financing Administration of the United States Department of Health and Human Services (HCFA) is the federal agency for administering the Medicaid program. HCFA regulations permit the Department to determine which pharmaceutical services to cover, and require the Department to establish policies and methods for reimbursing providers of such services to Medicaid recipients. Accordingly, the Department promulgated Chapter 10, Pharmaceutical Services, to establish the scope of covered pharmaceutical services and policies and methods for reimbursing providers of such services.
The existing Chapter 10 is now being amended to reflect service changes in the Medicaid pharmaceutical services program. It is being promulgated to replace the existing Chapter 10.