Idaho Admin. Code r. 16.03.09.664

Current through September 2, 2024

Section 16.03.09.664 - PRESCRIPTION DRUGS: PROVIDER QUALIFICATIONS AND DUTIES

01.Payment for Covered Drugs. Payment will be made, as provided in Section 665 of these rules, only to pharmacies registered with the Department as a provider for the specific location where the service was performed. An out of the state pharmacy shipping or mailing a prescription into Idaho must have a valid mail order license issued by the Idaho Board of Pharmacy and be properly enrolled as a Medicaid provider.

02.Dispensing Procedures. The following protocol must be followed for proper prescription filling.

a. Prescription Drug Refills. Refills of prescription drugs must be authorized by the prescriber on the original or new prescription order on file and each refill must be recorded on the prescription or logbook, or computer print-out, or on the participant's medication profile.

b. Automatic Refills.

i. Automatic refills are not allowed for Idaho Medicaid participants. A request specific to each medication is required.

ii. All prescription refills must be initiated by a request from the participant, the prescriber, or another person, such as a family member, acting as an agent of the participant.

iii. Authorization for each prescription refill must be received prior to the beginning of the filling process by the pharmacy.

c. Dispensing Prescription Drugs. Prescriptions must be dispensed according to:

i. 21 CFR Section 1300, et seq.;

ii. Title 54, Chapter 17, and Title 37, Chapters 1, 27, and 32, Idaho Code;

iii. IDAPA 27.01.03, "Rules Governing Pharmacy Practice"; and

iv. Sections 660 through 666 of these rules.

d. Prescriptions on File. Prescriptions must be maintained on file in pharmacies in such a manner that they are available for immediate review by the Department upon written request.

03.Return of Unused Prescription Drugs. When prescription drugs were dispensed in unit dose packaging, as defined by IDAPA 27.01.03, "Rules Governing Pharmacy Practice," and the participant for whom the drugs were prescribed no longer uses them:

a. A licensed skilled nursing care facility may return unused drugs dispensed in unit dose packaging to the pharmacy provider that dispensed the medication.

b. A residential or assisted living facility may return unused drugs dispensed in unit dose packaging to the pharmacy provider that dispensed the medication.

04.Pharmacy Provider Receiving Unused Prescription Drugs. In order for a pharmacy provider to receive unused prescription drugs that it dispensed in unit dose packaging and that are being returned by a facility identified in Subsection 664.03 of this rule, the pharmacy provider:

a. Must comply with IDAPA 27.01.03, "Rules Governing Pharmacy Practice," regarding unit dose packaging;

b. Must credit the Department the amount billed for the cost of the drug less the professional dispensing fee; and

c. May receive a fee for acceptance of returned unused prescription drugs. The value of the unused prescription drug being returned must be such that return of the drug is cost-effective as determined by the Department.

Idaho Admin. Code r. 16.03.09.664

Effective March 17, 2022