55 Pa. Code § 1121.42 - Ongoing responsibilities of providers

In addition to the ongoing responsibilities established in Chapter 1101 (relating to general provisions) pharmacies shall, as a condition of participation, comply with the following requirements:

(1) Permit authorized State and Federal officials or their authorized agents to conduct onsite reviews for the purpose of verification of information furnished as a basis for payment under the MA Program and for establishing the pharmacy's usual and customary charge to the general public as defined in Chapter 1101. During the course of the review, the reviewers shall be allowed access to the dispensing area. The provider shall allow reviewers access to records and documents necessary to determine whether payment for services is or was due under the Program and whether services that have been and are being provided comply with Federal and State law. The reviewer shall be allowed to photocopy, or duplicate these records and documents. These records include:

(i) MA prescriptions on file.

(ii) Non-MA prescriptions without the reviewer having access to patient identification.

(iii) Pharmaceutical purchase invoices.

(iv) The pricing system used by the store, including but not limited to, pricing rolodex, patient profile and pricing codes.

(v) Price lists attached to prescription containers.

(2) Conform to accepted standards of practice and quality of service when dispensing prescriptions to MA recipients. It shall be considered contrary to accepted standards of practice for a pharmacy to differentiate between MA recipients and the general public, as defined in Chapter 1101.

Notes

55 Pa. Code § 1121.42

This section cited in 55 Pa. Code § 1121.71 (relating to scope of claims review procedures).