D.C. Mun. Regs. tit. 29, r. 29-2702

Current through Register 71, No. 45, November 7, 2024

Rule 29-2702 - PROFESSIONAL DISPENSING FEE

2702.1

Medicaid reimbursement of covered outpatient drugs to fee for service pharmacies shall include a professional dispensing fee. A professional dispensing fee is a fee that:

(a) Is incurred at the point of sale or service;

(b) Pays for pharmacy costs in excess of the ingredient cost of a covered outpatient drug each time a covered outpatient drug is dispensed;

(c) Includes only pharmacy costs associated with ensuring that possession of the appropriate covered outpatient drug is transferred to a Medicaid beneficiary. Pharmacy costs include, but are not limited to reasonable costs associated with delivery, special packaging and overhead associated with maintaining the facility and equipment necessary to operate the pharmacy, and a pharmacist's time spent :

(1) Checking the computer for information about an individual's coverage

(2) Performing drug utilization review and preferred drug list review activities;

(3) Measur ing or mixing of the covered outpatient drug;

(4) Filling the container;

(5) Counseling a beneficiary; and

(6) Physically providing the completed prescription to the Medicaid beneficiary.

2702.2

The professional dispensing fee shall not include administrative costs incurred by the District in the operation of the covered outpatient drug benefit including systems costs for interfacing with pharmacies.

D.C. Mun. Regs. tit. 29, r. 29-2702

Notice of Final Rulemaking published at 59 DCR 2298, 2301 (March 23, 2012); amended by Final Rulemaking published at 65 DCR 7824 (7/27/2018)

Authority: The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code § 1-307.02 (2006 Repl. & 2011 Supp.)) and section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2008 Repl.)).