55 Pa. Code § 1121.2
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
AWP-The average wholesale price for a drug as found in the Department's pricing service publication.
Brand name-A registered trade name commonly used to identify a drug.
CMS-The Centers for Medicare and Medicaid Services.
CMS multisource drug-A multisource drug identified by CMS for which FFP is limited under 42 CFR 447.331 - 447.333 (relating to drugs: aggregate upper limits of payment; upper limits for multiple source drugs; state plan requirements, findings and assurances).
Compounded prescription-A prescription that is prepared in the pharmacy by combining two or more ingredients and involves the weighing of at least one solid ingredient which shall be a compensable item or a legend drug in a therapeutic amount.
DESI drug-A drug product for which Federal Financial Participation FFP is not available under 42 CFR 441.25 (relating to less than effective drugs).
EAC-Estimated Acquisition Cost-As defined in 42 CFR 447.301 (relating to definitions).
Experimental drug-A drug or product currently being investigated under licensure by the FDA to determine its safety and effectiveness.
FDA-Food and Drug Administration.
FFP-Federal financial participation.
Federal upper limit-The per unit amount set for a multisource drug which is established by CMS under 42 CFR 447.332.
Generic drug-A drug that is "A-rated" by the FDA as therapeutically equivalent to the counterpart brand name drug.
Legend drug-A drug or product that under Federal law or State law can be dispensed only upon the order of a physician.
Licensed prescriber-A person currently licensed under the law of a state to order medication.
Multisource drug-A drug marketed or sold by two or more manufacturers or labelers or a drug marketed or sold by the same manufacturer or labeler under two or more different proprietary names or both under a proprietary name and without such a name.
Nonlegend drug-A drug or product that can be purchased without a prescription.
OBRA '90-The Omnibus Budget Reconciliation Act of 1990 (Pub. L. No. 101-508, 104 Stat. 1388).
Pricing service-A third-party source that compiles and provides drug-specific information needed to maintain the drug refernece file under this chapter.
State MAC-The maximum allowable cost established for a multisource drug.
Usual and customary charge-The pharmacy's lowest net charge an MA recipient would pay for a prescription as a non-Medicaid patient at the time of dispensing for the same quantity and strength of a particular drug or product, including applicable discounts, such as special rates to nursing home residents, senior citizens, or other discounts extended to a particular group of patients, including generic drug discount and savings programs. This lowest net price does not apply to special in-store rates or discounts extended to charitable organizations, religious groups, store employees and their families, nonprofit organizations, members of the medical profession or other similar non-Medicaid groups.
WAC-Wholesale Acquisition Cost-The manufacturer's list price for a drug to wholesalers or direct purchasers in the United States as listed in one or more available Nationally recognized pricing services.
55 Pa. Code § 1121.2
This regulation was promulgated under section 6(b) of the Regulatory Review Act (71 P. S. § 745.6(b)).
The provisions of this §1121.2 amended under sections 201(2), 403(b), 403.1, 443.4 and 454 of the Public Welfare Code (62 P. S. §§ 201(2), 403(b), 403.1, 443.4 and 454).