| |
| Outpatient drug program—General. |
| Definitions. |
| Requirements—Use of tamper-resistant prescription pads. |
|
| Covered—Outpatient drugs, devices, and drug-related supplies. |
| Noncovered—Outpatient drugs and pharmaceutical supplies. |
|
| When the medicaid agency requires authorization. |
| How the medicaid agency determines when a drug requires authorization. |
| The medicaid agency's authorization process. |
|
| Drug use review (DUR) board. |
| Drug use and claims review. |
| Medicaid preferred drug list (medicaid PDL). |
| Generics first for a client's first course of treatment. |
| Therapeutic interchange program (TIP). |
|
| Billing requirements—Pharmacy claim payment. |
| Billing requirements—Point-of-sale (POS) system/prospective drug use review (Pro-DUR). |
| Billing requirements—Unit dose. |
|
| Mail-order and specialty pharmacy services. |
|
| Reimbursement. |
| Reimbursement—Dispensing fee determination. |
| Reimbursement—Pharmaceutical supplies. |
| Reimbursement—Compounded prescriptions. |
| Reimbursement—Out-of-state prescriptions. |
| Reimbursement—Miscellaneous. |
| Reimbursement—Requesting a change. |
| Reimbursement—Unit dose drug delivery systems. |
| Reimbursement—Compliance packaging services. |
| Drug rebate requirement. |
| Reimbursement—Clients enrolled in managed care. |
| Reimbursement—Dual eligible clients/medicare. |
| Reimbursement—Clients with third-party liability. |
| Drugs purchased under the Public Health Service (PHS) Act. |
REIMBURSEMENT METHODOLOGY |
| Reimbursement method—Actual acquisition cost (AAC). |
| Reimbursement—Federal upper limit (FUL). |
| Reimbursement—Maximum allowable cost (MAC). |
| Reimbursement—Automated maximum allowable cost (AMAC). |