Kan. Admin. Regs. § 30-5-92 - Scope of pharmacy services
(a) The medical
services provided to program recipients shall include pharmacy services.
(1) Kan Be Healthy participants shall be
limited to those prescription-only and over-the-counter drugs, supplies, and
devices that have been accepted for inclusion on any formulary listing for Kan
Be Healthy participants adopted and distributed by the secretary to eligible
providers of service.
(2) Other
medicaid recipients shall be limited to those prescription-only and
over-the-counter drugs, supplies, and devices that have been accepted for
inclusion on any formulary listing for other medicaid recipients adopted and
distributed by the agency to eligible providers of service.
(b) Covered drugs, supplies, and
devices shall be prescribed by the recipient's attending practitioner and
dispensed in a pharmacy by a pharmacist, with the exception of those drugs,
supplies, or devices designated by the secretary.
(c) Each provider of pharmacy services shall
comply with the provisions of K.A.R. 30-5-59 and shall be assigned a pharmacy
services provider number.
(d)
(1) Each pharmacist shall dispense each
brand-name legend drug as prescribed if either of the following conditions is
met:
(A) The pharmacist receives a written
prescription on which the prescriber has signed on the "dispense as written"
signature line or has personally handwritten "dispense as written" or "D.A.W."
on the prescription.
(B) The
pharmacist receives an oral prescription in which the prescriber has expressly
indicated that the prescription is to be dispensed as communicated.
(2) Each pharmacist shall dispense
the generic form of a prescribed brand-name drug, after disclosing the
substitution to the consumer, if all of the following conditions are met:
(A) The pharmacist receives either of the
following:
(i) a written prescription on
which the prescriber has neither signed on the "dispense as written" signature
line nor personally handwritten "dispense as written" or "D.A.W." on the
prescription; or
(ii) an oral
prescription in which the prescriber has not expressly indicated that the
prescription is to be dispensed as communicated.
(B) There is available in the pharmacist's
stock a less expensive generic drug that is rated bioequivalent (AB-rated) by
the food and drug administration.
(C) In the pharmacist's professional
judgment, the generic drug is safely interchangeable with the prescribed drug.
A pharmacist may also make a substitution in a manner consistent with the oral instructions of the prescriber. The pharmacist shall notify the consumer if the pharmacist is dispensing a drug other than the brand-name drug prescribed.
(3) If more than one safely interchangeable
generic drug is available in the pharmacist's stock, then the pharmacist shall
dispense the least expensive alternative.
(4) Nothing in this subsection shall be
deemed to require a pharmacist to substitute a generic drug if the substitution
will make the transaction ineligible for reimbursement.
(5) If a pharmacist dispenses a brand-name
legend drug and, at that time, a less expensive generic drug is also available
in the pharmacist's stock, the pharmacist shall disclose to the consumer that a
generic drug is available.
(e) If a drug product is issued to a patient
of a long-term care facility and subsequently is not used, the long-term care
facility shall return the drug product to the vendor pharmacy for repackaging
and crediting to the secretary if the drug product meets all of the following
conditions:
(1) The drug product is a
prescription drug product that is not a controlled substance.
(2) The drug product is sealed in
individually packaged units or in a multiple-dose, sealed container approved by
the federal food and drug administration from which no doses have been
withdrawn.
(3) The drug product is
returned to the vendor pharmacy at least 90 days before the expiration date.
(4) The drug product is determined
to be of acceptable integrity by a licensed pharmacist.
(f) Each long-term care facility shall
establish procedures for the return of unused drug products to the vendor
pharmacy from which the unused drug products were received.
(g) Each provider of pharmacy services may be
reimbursed the reasonable cost of returning and crediting unused drug products,
as determined by the secretary.
(h) After prior notification of each
provider, reimbursement under the program may be denied for any of the
following:
(1) Certain drugs, supplies, and
devices determined by the secretary to be less than effective;
(2) drugs, supplies, and devices that do not
meet the requirements of section 1927 of the social security act, 42 U.S.C. 1396r-8, as amended Nov. 29, 1999, which is adopted by reference, pertaining to
available rebates or the medical necessity of the drug, supply, or device; or
(3) drugs, supplies, or devices
restricted by the secretary under the provisions of section 1927 of the social
security act, 42 U.S.C. 1396r-8 regarding permissible restrictions.
Selected drugs, supplies, and devices shall be considered for coverage only when prior authorization criteria are met.
(i) Pharmacy services provided for
parenteral administration of total nutritional replacements in the consumer's
home shall not be covered through the pharmacy program and shall be billed
through the durable medical equipment program.
(j) The total number of prescriptions that
any recipient may receive in a given time period shall be limited as determined
by the secretary.
(k) Selected
pharmacy services shall be limited to a dollar value for a given time period as
determined by the secretary.
Notes
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