La. Admin. Code tit. 40 § I-2907

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-2907 - Reimbursement

A. Payment for brand-name pharmaceuticals including oral non-legend drugs will be made at the lesser of:

1. the provider's usual charge;

2. a provider/insurer contracted charge; or

3. the average wholesale price (AWP) plus 10 percent plus a dispensing fee equal to the Medicaid dispensing fee set by the state of Louisiana, Department of Health and Hospitals.

B. Payment for generic pharmaceuticals will be made at the lesser of:

1. the provider's usual charge;

2. a provider/insurer contracted charge; or

3. the average wholesale price (AWP) plus 40 percent, plus a dispensing fee equal to the Medicaid dispensing fee set by the state of Louisiana, Department of Health and Hospitals.

C. The average wholesale prices (AWPs) for brand-name and generic pharmaceuticals will be the AWP listed in the most recent monthly update of the Annual Pharmacists' Reference Red Book available from:

Medical Economics Company, Inc.

680 Kinderkamack Road

Oradell, NJ 07649

Phone (800) 526-4870

D. Compounded prescriptions will be paid utilizing the same reimbursement formula as generic drugs. Please write "COMPOUND RX" directly above the RX# field on the Drug Claim Form.

E. When not in conflict with physician's orders and/or when not contrary to stop orders, medications should be dispensed in quantities sufficient to last 30 days except pharmaceuticals which could be considered "one-a-day, long-term maintenance" drugs, which may be dispensed in 100 unit dose quantities.

F. Refills will be permitted on an original prescription for a period of not more than one year from the date of such prescription, subject to applicable laws and regulations and only in accordance with the authorization of the prescribing physician.

La. Admin. Code tit. 40, § I-2907

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.