Or. Admin. Code § 410-146-0200 - Pharmacy

(1) A valid encounter excludes pharmaceutical or biologicals not generally provided during a clinic visit:

(a) An IHS or Tribal 638 Pharmacy may select whether to be reimbursed by the Division for prescriptions, including dispensing services, at the appropriate 340(B) or Federal Supply Schedule Acquisition Rate (refer to OAR 410-121-0160) plus the dispensing fee as determined by the state, or at the All-Inclusive Rate (AIR) published annually by the IHS, inclusive of dispensing fees;

(b) An IHS or Tribal 638 Pharmacy may request to change from the appropriate 340(B) or Federal Supply Schedule Acquisition Rate plus a dispensing fee methodology, to the IHS All-Inclusive Rate (AIR) methodology, or from the IHS AIR methodology to the appropriate 340(B) or Federal Supply Schedule Acquisition Rate (AAC) plus dispensing fee methodology, but no more frequently than four times in a calendar year. Requests must be submitted at least 30 days in advance and shall be effective at the start of the following quarter. If an IHS or Tribal 638 Pharmacy experiences circumstances requiring a methodology change, the 30 day advance notice may be waived and the process.

(2) IHCPs may bill directly the Division only for contraceptive supplies and contraceptive medications outside of the pharmacy program:

(a) For clients enrolled with a PHP, IHCPs must bill the PHP first. If the PHP will not reimburse for the contraceptive supply or contraceptive medication, then the clinic may bill the Division fee-for-service at the clinic's acquisition cost. See also OAR 410-130-0585, Family Planning Services;

(b) For clients not enrolled with a PHP, IHCPs may bill directly the Division fee-for-service at the clinic's acquisition cost for contraceptive supplies and contraceptive medications. See also OAR 410-130-0585, Family Planning Services.

(3) Refer to OAR 410 division 121, Pharmaceutical Services program for specific information.

Notes

Or. Admin. Code § 410-146-0200

OMAP 2-1999, f. & cert. ef. 2-1-99; OMAP 25-2000, f. 9-28-00, cert. ef. 10-1-00; OMAP 6-2001, f. 3-30-01, cert. ef. 4-1-01; OMAP 45-2001, f. 9-24-01, cert. ef. 10-1-01; OMAP 39-2002, f. 9-13-02, cert. ef. 9-15-02; OMAP 59-2002, f. & cert. ef. 10-1-02; DMAP 19-2007, f. 12-5-07, cert. ef. 1-1-08; DMAP 24-2008, f. 6-13-08, cert. ef. 7-1-08; DMAP 42-2017, amend filed 10/03/2017, effective 10/3/2017

Statutory/Other Authority: ORS 413.042 & ORS 414.065

Statutes/Other Implemented: ORS 414.065