DAR File No. 41379

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-60-2

Definitions

Notice of Proposed Rule

(Amendment)

DAR File No.: 41379
Filed: 03/20/2017 02:45:33 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to clarify the definition of a "covered outpatient drug".

Summary of the rule or change:

This amendment clarifies the definition of a "covered outpatient drug".

Statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this amendment only clarifies a definition. It neither affects prescribed drug services nor drug reimbursement.

local governments:

There is no impact to local governments because this amendment only clarifies a definition. It neither affects prescribed drug services nor drug reimbursement.

small businesses:

There is no impact to small businesses because this amendment only clarifies a definition. It neither affects prescribed drug services nor drug reimbursement.

persons other than small businesses, businesses, or local governmental entities:

There is no impact to Medicaid clients and to Medicaid providers because this amendment only clarifies a definition. It neither affects prescribed drug services nor drug reimbursement.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid client or to a Medicaid provider because this amendment only clarifies a definition. It neither affects prescribed drug services nor drug reimbursement.

Comments by the department head on the fiscal impact the rule may have on businesses:

There is no fiscal impact on business because the proposed rule does not change any requirements under the existing rule.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

05/15/2017

This rule may become effective on:

05/22/2017

Authorized by:

Joseph Miner, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-60. Medicaid Policy for Pharmacy Program.

R414-60-2. Definitions.

(1) "Covered outpatient drug" means a drug that meets all of the following criteria:

(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 [Medi-Span drug file]nationally recognized drug pricing index under contract with the Department.

(2) "Full-benefit dual eligible beneficiary" means an individual who has Medicare and Medicaid benefits.

(3) "Rural pharmacy" means a pharmacy located in the state of Utah, which is outside of Weber County, Davis County, Utah County, and 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" is the lowest amount a pharmacy charges the general public for a covered outpatient drug, which reflects all advertised savings, discounts, special promotions, or any other program available to the general public.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [December 1, 2016]2017

Notice of Continuation: April 30, 2012

Authorizing, and Implemented or Interpreted Law: 26-18-3; 26-1-5