Ill. Admin. Code tit. 89, § 140.447 - Reimbursement
a) The calculation
of average wholesale price in the determination of the Department's maximum
price (Section
140.445(b)
) is made using the standard package size.
b) If a pharmacy gives discounts to the
general public, it must provide the same to Public Aid recipients. If discounts
are allowed only to a specific group of people, they shall be extended to a
recipient if he or she is a member of the special discount group. Public Aid
recipients can constitute a special group and receive a discount, but they
cannot be excluded from a discount group just because they are
recipients.
c) The Department will
require pharmacies to complete hard copy (paper) claim forms for pharmacy
services and attach a Prescribing Practitioner Name Identification Form. A
separate hard copy (paper) claim form and Practitioner Name Identification Form
is to be required for each recipient and prescribing practitioner.
d) The Department will authorize an exception
for pharmacies, to the requirements of subsection (c) of this Section, by
allowing pharmacy claims to be submitted with the prescribing practitioner's
DEA number, Department Medical Assistance Program participating provider
identification number or Social Security Number.
Notes
Amended at 25 Ill. Reg. 14957, effective November 1, 2001
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