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Pharmacy Purchases and Billing

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Pharmacy Purchases and Billing

Current Effective Date:


Revision History:

Revised 08/00; 04/06

Prescription Legend Drugs and Insulin

Prescription legend drugs and insulin may be provided for eligible individuals who are meet Financially Responsibility/Economic Need Requirements (On-Line DSB-4040-VR Economic Need Survey with instructions) eligible and have no comparable benefits. Vocational Rehabilitation Counselors should be ever cognizant that these items are purchased for stabilizing conditions. When maintenance dosages are achieved, other means should be procured.

The Division of Services for the Blind (DSB) will purchase prescription legend drugs at the Medicaid rate of reimbursement, plus the Medicaid approved professional dispensing fee in effect at the time the prescription is dispensed. A professional dispensing fee will not be charged for the second or subsequent times when the same drug or generic equivalent drug is dispensed more than once in the same calendar month.

Individuals may have a free choice of pharmacies that have signed a working Pharmacy Agreement (On-Line-MED.EYE DSB-4020 Pharmacy Agreement) with the DSB. The original agreement will be transmitted to the Claims Processing Section in the Department of Health and Human Services (DHHS) Controller’s Office. A copy of the agreement will be maintained by the District Office or facility in a file marked “Pharmacy Agreement.” The pharmacy shall also retain a copy. It will be the Vocational Rehabilitation Counselor’s responsibility to complete an agreement with each pharmacy from which medications and/or related supplies are purchased; the Vocational Rehabilitation Counselor is authorized to approve the agreement for the Agency. The terms of the agreement will be effective for one year from date of signing unless cancelled by the Agency or the pharmacy upon a written 30-day notice prior to termination or immediately with cause by either party. Only one agreement is required per pharmacy.

Authorizations will be utilized for authorizing prescription legend drugs and insulin. When issuing an authorization, the pharmacy claim will no longer need to be attached as the form is available directly from the following web addresses by scrolling down to the forms section and selecting Services for the Blind Pharmacy Claim (On-Line-MED.EYE DSB-0511 Pharmacy Claim): Office of Controllers Purchase of Medical Care Services.

The pharmacist will send the invoice to the office issuing the authorization.

The Area Vocational Rehabilitation Supervisor will be responsible for monitoring authorizations for prescription legend drugs based on time frames and number of refills which authorizations cover.

Once the service has been authorized, the pharmacy will complete Pharmacy Claim and return the completed form to the Vocational Rehabilitation Counselor who will send the completed original form with the authorization to the Claims Processing section in the DHHS Controller’s Office who will have the responsibility to insure that the amount billed is correctly according to the maximum cost allowed by the Medicaid Program. A copy will be retained in the case file. (Please note that the client p-card cannot be used for pharmacy purchases.)

Before approving a bill, the Vocational Rehabilitation Counselor should determine if the dispensing fee has not been charged more than once in a calendar month per prescription medication per individual. If an additional dispensing fee has been charged by the pharmacy during the calendar month, the Vocational Rehabilitation Counselor should mark through the charge before submitting for payment.

Non-Prescription Non-Legend Drugs and Prescription Accessories

Orders for non-prescription non-legend drugs and prescription accessories are reimbursable following review and prior authorization by the Vocational Rehabilitation Counselor. Non-prescription non-legend drugs and prescription accessories will be billed at the customary over-the-counter prices. Authorizations should be issued for these items at “Customary Over-The-Counter Prices.”

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  For questions or clarification on any of the policy contained in these manuals, please contact the local district office.

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