Section 140.414 Requirements for Prescriptions and Dispensing of Pharmacy Items – Prescibers

Section 140

TITLE 89: SOCIAL SERVICES

CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES

SUBCHAPTER d: MEDICAL PROGRAMS

PART 140 MEDICAL PAYMENT

SECTION 140.414 REQUIREMENTS FOR PRESCRIPTIONS AND DISPENSING OF PHARMACY ITEMS – PRESCIBERS

Section 140.414  Requirements

for Prescriptions and Dispensing of Pharmacy Items – Prescibers

For the purpose of this Section,

"prescriber" shall mean any person who, within the scope of his or

her professional licensing requirements, may prescribe or dispense drugs.

a)         Prescriptions

1)         A prescriber may prescribe any pharmacy item, not otherwise

excluded, that, in the prescriber's professional judgment, is essential for the

diagnosis or accepted treatment of a recipient's present symptoms.  The

Department may require prior approval of any drug except as outlined in Section

140.442(a)(9).

2)         A prescriber shall:

A)        Use a tamper-resistant prescription form, as defined at Section

140.443(b)(2), for non-electronic prescriptions.  Non-electronic prescriptions

are defined at Section 140.443(b)(1).  In addition, the prescriber shall ensure

the prescription form is compliant with Section 3(e) of the Pharmacy Practice

Act of 1987 [225 ILCS 85/3(e)], 68 Ill. Adm. Code 1330 and 42 USC 1936(i)(23);

and

B)        Enter on the form all data elements required under Section 3(e)

of the Pharmacy Practice Act of 1987 [225 ILCS 85/3(e)], 68 Ill. Adm. Code 1330

and 42 USC 1936(i)(23), as well as one of the following data elements

identifying the prescriber:

i)          Drug

Enforcement Administration (DEA) Number; or

ii)        National Provider Indentifier (NPI); or

iii)       Medical Assistance Program Provider Number; or

iv)       Illinois State License Number.

3)         The prescriber shall not charge for writing a prescription.

4)         Items that shall not be prescribed are listed in Section

140.441

ta elements

identifying the prescriber:

i)          Drug

Enforcement Administration (DEA) Number; or

ii)        National Provider Indentifier (NPI); or

iii)       Medical Assistance Program Provider Number; or

iv)       Illinois State License Number.

3)         The prescriber shall not charge for writing a prescription.

4)         Items that shall not be prescribed are listed in Section

140.441.

b)         Dispensed

Items

1)         A participating prescriber may dispense pharmacy items subject

to the Department's coverage policies.  The prescriber shall not charge for any

samples dispensed or anesthesia agents administered for office surgical

procedures.

2)         Effective July 1, 2012, the Department shall pay for covered

outpatient drug items dispensed or administered by a non-pharmacy provider at a

rate equal to the lowest of the provider's usual and customary charge to the

public; or

A)        The

Average Sales Price (ASP) plus 6 percent.  ASP means the ASP as defined in the

Social Security Act, Title XVIII, section 1847A(c) (42 USC 1395 w-3a(c)) and

calculated by the federal Centers for Medicare and Medicaid Services (CMMS); or

B)        The

State upper limit.

3)         Effective

July 1, 2012, in cases in which ASP is not available and no State upper limit

has been developed, the Department's lowest maximum allowable price for all

covered NDCs assigned to the HCPCS billing code (the methodology for

determining the Department's maximum prescription prices is specified in Section

140.445(b)(1) and (b)(2)).

4)         Reimbursement

rates for drugs dispensed or administered by non-pharmacy providers shall be

updated no less frequently than twice per calendar year.