Section 85.22 - Maximum reimbursable price and limitations on reimbursement for nonprescription drugs

85.22 Maximum reimbursable price and limitations on reimbursement for nonprescription drugs. Pursuant to section 365-a of the Social Services Law, the amount which may be reimbursed for those nonprescription drugs specified in this Part by the commissioner as a reimbursable item of medical assistance shall be the lower of:

(a) the provider's usual and customary price to the general public on the date of provision of service, but not to exceed the lower sale price, if any, in effect on that date; or

(b) the maximum reimbursable price established and maintained by the commissioner.
(c) Reimbursement shall not be available under the medical assistance program for any nonprescription drug in the following categories:

(1) A drug regularly supplied as an integral part of a medical care program activity to a Medicaid recipient by private, voluntary or public agency such as the Veterans Administration, Department of Health and Human Services, State Department of Health or other funded programs.

(2) Any drug for which there are low-cost alternatives if purchased by a Medicaid recipient, either nonprescription or prescription drugs.

(3) Any drug considered ineffective in accordance with standards developed by the Food and Drug Administration.

(4) Any drug sold after the expiration date printed on the container label.

(5) Any drug in a container whose expiration date has been altered, mutilated, destroyed, obliterated or removed by means of an affixed price sticker or other change.

Effective Date: 
Wednesday, November 26, 2008
Doc Status: 
Complete