048-10 Wyo. Code R. § 10-8

Current through April 27, 2019

Section 10-8 - Covered Services

(a) Prescription drugs. Prescription drugs are covered in the quantity prescribed by a practitioner, subject to the dispensing limitations of Section 9 and the exclusions of Section 11.

(b) Refill of prescription. In addition to the criteria specified in subsection (a), a refill of a prescription shall:

(i) Be authorized by the practitioner who originally prescribed the drug;

(ii) Conform to State and Federal laws governing prescription refills; and

(iii) Be within one (1) year of the date of the original prescription.

(c) Brand name drugs. Non-preferred brand name drugs with multi-source generics shall be certified in writing by the prescribing practitioner as medically necessary.

(d) Compound drugs. Compound drugs shall be paid per line item if each ingredient is a prescription or Over-the-Counter (OTC) drug covered pursuant to subsections (a) and (e) and is not classified by the FDA as a Drug Efficacy Study Implementation (DESI) drug. One (1) dispensing fee is paid per compound prescription.

(e) OTC drugs and medical supplies. Select OTC drugs and medical supplies are covered pharmacy services if they:

(i) Are dispensed to a client who is not a resident of a nursing facility, not admitted as an inpatient or outpatient in a hospital, and not occupying a swing bed;

(ii) Are prescribed by a practitioner;

(iii) Are rebatable OTC drugs;

(iv) Have been assigned a National Drug Code (NDC) number; and

(v) Are medically necessary.
- (A) The Department shall, from time to time, designate OTC drugs and medical supplies as covered services based on their therapeutic value, clinical consultation with practitioners, and applicable Centers for Medicare and Medicaid Services (CMS) guidelines. The Department shall disseminate current lists of covered OTC drugs and medical supplies to providers through manuals, bulletins, facsimiles, designated websites, or other appropriate means.

048-10 Wyo. Code R. § 10-8

Amended, Eff. 3/25/2019.