Section 405 IAC 5-24-6 - Professional dispensing feeAuthority: IC 12-15
Affected: IC 12-13-7-3
Sec. 6.
(a) For purposes of this rule, the Medicaid professional dispensing fee maximum is ten dollars and forty-eight cents ($10.48).(b) A maximum of one (1) Medicaid professional dispensing fee per month is allowable per member per drug order for legend or nonlegend drugs provided to members residing in Medicaid certified long-term care facilities.(c) The practice of split billing of legend or nonlegend drugs, defined as the dispensing of less than the prescribed amount of drug solely for the purpose of collecting more Medicaid professional dispensing fees than would otherwise be allowed, or to circumvent prior authorization criteria, is prohibited. In cases in which the pharmacist's professional judgment dictates that a quantity less than the amount prescribed be dispensed, the pharmacist should contact the prescribing practitioner for authorization to dispense a lesser quantity. The pharmacist must document the result of the contact and the pharmacist's rationale for dispensing less than the amount prescribed on the prescription or in the pharmacist's records. Office of the Secretary of Family and Social Services; 405 IAC 5-24-6; filed Jul 25, 1997, 4:00 p.m.: 20 IR 3345; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed Aug 29, 2001, 9:50 a.m.: 25 IR 60 [NOTE: On October 9, 2001, the Marion Superior Court issued an Order in Cause No. 49D05-0109-CP-1480, enjoining the Family and Social Services Administration from implementing LSA Document #01-22(F), published at 25 IR 60.]; filed Apr 30, 2002, 10:59 a.m.: 25 IR 2727; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA; filed Nov 8, 2013, 2:56 p.m.: 20131204-IR-405130422FRAFiled 4/29/2015, 3:38 p.m.: 20150527-IR-405150034FRAFiled 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRAFiled 3/2/2017, 3:39 p.m.: 20170329-IR-405160530FRAFiled 4/29/2019, 10:35 p.m.: 20190529-IR-405180482FRAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA