Section R414-60-2 - Definitions(1) "Covered outpatient drug" means a drug that meets the Centers for Medicare and Medicaid Services (CMS) covered outpatient drug definition as outlined in 42 CFR 447.502. The following provisions also apply: (a) requires a prescription for dispensing;(b) has a national drug code number;(c) is eligible for federal medical assistance percentages funds;(d) has been approved by the Food and Drug Administration; and(e) is listed in the nationally recognized drug pricing index under contract with the Department.(2) "Full-benefit dual eligible member" means an individual who has Medicare and Medicaid benefits.(3) "Rural pharmacy" means a pharmacy located in the state and is not located in Weber County, Davis County, Utah County, or Salt Lake County.(4) "Urban pharmacy" means a pharmacy located in Weber County, Davis County, Utah County, Salt Lake County, or in another state.(5) "Usual and customary charge" means the lowest amount a pharmacy charges the general public for a covered outpatient drug, which reflects advertised savings, discounts, special promotions, or any other program available to the general public.(6) "Wholesale acquisition cost" means the list price paid by the wholesaler, distributor, and other direct accounts for drugs purchased from the wholesaler's supply.(7) "Medically accepted indication" in accordance with 42 U.S.C. 1396r-8 (k)(6), is any use approved by the Food and Drug Administration (FDA) and Cosmetic Act, or a use supported on one of the following compendia: (a) American Hospital Formulary Service Drug Information;(b) United State Pharmacopeia-Drug Information; or(c) the DRUGDEX Information SystemUtah Admin. Code R414-60-2
Amended by Utah State Bulletin Number 2016-24, effective 12/1/2016Amended by Utah State Bulletin Number 2017-13, effective 6/14/2017Amended by Utah State Bulletin Number 2020-23, effective 11/19/2020Amended by Utah State Bulletin Number 2021-02, effective 1/12/2021Amended by Utah State Bulletin Number 2023-20, effective 10/11/2023