Utah Admin. Code R414-60-2 - Definitions
(1) "Covered outpatient drug" means a drug
that meets the Centers for Medicare and Medicaid Services (CMS) covered
outpatient drug definition as outlined in
42 CFR
447.502. The following provisions also apply:
(a) requires a prescription for
dispensing;
(b) has a national drug
code number;
(c) is eligible for
federal medical assistance percentages funds;
(d) has been approved by the Food and Drug
Administration; and
(e) is listed
in the nationally recognized drug pricing index under contract with the
Department.
(2)
"Full-benefit dual eligible member" means an individual who has Medicare and
Medicaid benefits.
(3) "Rural
pharmacy" means a pharmacy located in the state and is not located in Weber
County, Davis County, Utah County, or Salt Lake County.
(4) "Urban pharmacy" means a pharmacy located
in Weber County, Davis County, Utah County, Salt Lake County, or in another
state.
(5) "Usual and customary
charge" means the lowest amount a pharmacy charges the general public for a
covered outpatient drug, which reflects advertised savings, discounts, special
promotions, or any other program available to the general public.
(6) "Wholesale acquisition cost" means the
list price paid by the wholesaler, distributor, and other direct accounts for
drugs purchased from the wholesaler's supply.
(7) "Medically accepted indication" in
accordance with 42 U.S.C.
1396r-8 (k)(6), is any use approved by the
Food and Drug Administration (FDA) and Cosmetic Act, or a use supported on one
of the following compendia:
(a) American
Hospital Formulary Service Drug Information;
(b) United State Pharmacopeia-Drug
Information; or
(c) the DRUGDEX
Information System
Notes
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