Kan. Admin. Regs. § 30-5-94 - Reimbursement for pharmacy services
(a) Each pharmacy
provider shall be reimbursed for covered pharmacy services on the basis of
product acquisition cost plus a dispensing fee. In no case shall reimbursement
for a prescription exceed the lesser of the provider's usual and customary
charge for that prescription or the state allowable for that prescription. The
submitted charge and payment for covered over-the-counter pharmacy products
shall not exceed the lesser of the product acquisition cost plus the dispensing
fee or the usual and customary over-the-counter charge of the pharmacy
provider.
(b) The acquisition cost
shall include a maximum allowable cost for selected multiple-source drugs as
determined by the secretary.
(c)
The dispensing fee assigned to pharmacy providers shall be $3.40 per
prescription unless a different rate is established by the secretary.
(d) If an inactive pharmacy wishes
to become an active provider, the pharmacy shall reapply according to K.A.R.
30-5-59.
(e) In areas in which
pharmacy services are not available, each physician dispensing prescriptions to
consumers shall be eligible to receive reimbursement for provision of those
services after a pharmacy provider number has been issued by the department
according to K.A.R. 30-5-59.
(1) Each
physician assigned a pharmacy provider number shall be reimbursed on the basis
of product acquisition cost plus a dispensing fee of $.74 per prescription.
(2) The physician shall not be
reimbursed a dispensing fee for injectable drugs administered in the office,
except as included in the charge for the professional services of the
physician.
(f) Each
pharmacy provider shall be reimbursed only when the covered service has been
prescribed by the consumer's attending practitioner.
(g) This regulation shall be effective on and
after December 31, 2002.
Notes
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