405 Ind. Admin. Code 5-24-5

Current through August 28, 2024

Section 405 IAC 5-24-5 - Reimbursement for nonlegend drugs

Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2

Affected: IC 12-13-7-3; IC 12-15

Sec. 5.

(a) The office shall reimburse pharmacy providers for nonlegend (over-the-counter or OTC) drugs at the lower of the following:

(1) the state over-the-counter maximum allowable cost plus professional dispensing fee; or

(2) the provider's submitted charge, representing the provider's usual and customary charge for the drug, as of the date of dispensing.

(b) Only those nonlegend drugs that are included on the OTC drug formulary are covered by Indiana health coverage programs (IHCP).

405 IAC 5-24-5

Office of the Secretary of Family and Social Services; 405 IAC 5-24-5; filed Jul 25, 1997, 4:00 p.m.: 20 IR 3345; filed Sep 27, 1999, 8:55 a.m.: 23 IR 319; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed Nov 23, 2005, 11:30 a.m.: 29 IR 1212; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA

Errata filed 11/1/2016, 9:36 a.m.: 20161109-IR-405160493ACA

Filed 3/2/2017, 3:39 p.m.: 20170329-IR-405160530FRA

Filed 4/29/2019, 10:35 p.m.: 20190529-IR-405180482FRA

Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA