048-10 Wyo. Code R. § 10-14

Current through April 27, 2019

Section 10-14 - Copayment

(a) Clients shall pay a three dollar and sixty-five cent ($3.65) per prescription copayment for Brand Name drugs, or a sixty-five cent ($0.65) per prescription copayment for multiple source drugs, except as specified in subsection (b).

(b) Exemptions. The following clients and pharmaceutical services are exempt from the copayment requirement:

(i) Residents of a nursing facility or swing beds;

(ii) Family planning products;

(iii) Pregnant clients;

(iv) Clients under age twenty-one (21) years;

(v) American Indians and Alaska Natives;

(vi) Emergency Services;

(vii) Hospice Services; and

(viii) Vaccine products administered in the pharmacy.

(c) Notification of copayment amount. The Department shall notify providers of the copayment amount by means including, but not limited to, manuals, bulletins, facsimiles, or designated websites. The Department shall notify clients by bulletin or other means of communication designated by the Department.

(d) Collection of copayment. Providers are responsible for collecting the copayment. The amount of the copayment shall be automatically deducted by the Department from the Medicaid allowable payment, regardless of whether the copayment is actually collected.

(e) Denial of services. A provider may not deny pharmaceutical services to a client because of the client's inability to make the copayment, except when a client regularly refuses to make copayments.

(i) For purposes of this Section, a client who refuses to make a copayment two (2) or more times has "regularly refused" to make copayments.

048-10 Wyo. Code R. § 10-14

Amended, Eff. 3/25/2019.