405 IAC 5-24-7 - Copayment for legend and nonlegend drugs
Authority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15-6
Sec. 7.
(a) Under IC
12-15-6, a copayment is required for legend and nonlegend drugs in accordance
with the following:
(1) The copayment shall be
paid by the member and collected by the provider at the time the service is
rendered. Medicaid reimbursement to the provider shall be adjusted to reflect
the copayment amount for which the member is liable.
(2) In accordance with
42 CFR
447.15, the provider may not deny services to
any eligible individual on account of the individual's inability to pay the
copayment amount. Under 42
CFR 447.15, this service guarantee does not
apply to an individual who is able to pay, nor does an individual's inability
to pay eliminate his or her liability for the copayment.
(3) The amount of the copayment will be three
dollars ($3) for each covered drug dispensed. The pharmacy provider shall
collect a copayment for each drug dispensed by the provider and covered by
Medicaid.
(b) The
following pharmacy services are exempt from the copayment requirement:
(1) Emergency services provided in a
hospital, clinic, office, or other facility equipped to furnish emergency
care.
(2) Services furnished to
individuals less than eighteen (18) years of age.
(3) Services furnished to pregnant women if
such services are related to the pregnancy or any other medical condition that
may complicate the pregnancy.
(4)
Services furnished to individuals who are inpatients in hospitals, nursing
facilities, intermediate care facilities for individuals with intellectual
disabilities, or other medical institutions.
(5) Family planning services and supplies
furnished to individuals of child bearing age.
Notes
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Authority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15-6
Sec. 7.
(a) Under IC 12-15-6, a copayment is required for legend and nonlegend drugs in accordance with the following:
(1) The copayment shall be paid by the member and collected by the provider at the time the service is rendered. Medicaid reimbursement to the provider shall be adjusted to reflect the copayment amount for which the member is liable.
(2) In accordance with 42 CFR 447.15, the provider may not deny services to any eligible individual on account of the individual's inability to pay the copayment amount. Under 42 CFR 447.15, this service guarantee does not apply to an individual who is able to pay, nor does an individual's inability to pay eliminate his or her liability for the copayment.
(3) The amount of the copayment will be three dollars ($3) for each covered drug dispensed.
The pharmacy provider shall collect a copayment for each drug dispensed by the provider and covered by Medicaid.
(b) The following pharmacy services are exempt from the copayment requirement:
(1) Emergency services provided in a hospital, clinic, office, or other facility equipped to furnish emergency care.
(2) Services furnished to individuals less than eighteen (18) years of age.
(3) Services furnished to pregnant women if such services are related to the pregnancy or any other medical condition that may complicate the pregnancy.
(4) Services furnished to individuals who are inpatients in hospitals, nursing facilities, intermediate care facilities for individuals with intellectual disabilities, or other medical institutions.
(5) Family planning services and supplies furnished to individuals of child bearing age.