Title: Section 511.11 - Pharmacy services - utilization threshold.

511.11 Pharmacy services - utilization threshold. This section describes the utilization threshold that the department has established for pharmacy services. Beginning July 1, 1992, the department will pay for up to 28 pharmacy service formulary codes in a benefit year for MA recipients described in sections 360-3.3(a)(1) or 360-3.3(b)(7) of this Title. Beginning September 1, 1992, the department will pay for up to 40 pharmacy service formulary codes in a benefit year for MA recipients described in sections 360-3.3(a)(2)-(6), 360-3.3(b)(1)-(6), or 360-3.3(b)(8) of this Title. As used in this section, a formulary code is defined as follows:

(a) for prescription drugs, the first time a pharmacist fills a prescription is one formulary code; each refill of the original prescription is also one formulary code; and

(b) for nonprescription drugs and medical and surgical supplies, each initial fiscal order for the drug or supply is one formulary code; each refill of the fiscal order is also one formulary code.

 

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VOLUME C (Title 18)

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