§ 1181.257. Drug services.
(a) Allowable costs for drug services will be subject to the following conditions:
(1) A facility will be reimbursed for nonlegend drugs such as laxatives, aspirin, and antacids that are provided directly to an MA patient by a facility from its own supply.
(2) Detailed and itemized support documentation must be maintained for the claimed expense; otherwise, the expense will be disallowed.
(b) Any costs related to legend drugs for which payment would be made under the MA Program to an enrolled pharmacy or cost related to legend drugs that are noncompensable under the MA Program will not be considered as allowable costs for a facility. The Department will directly reimburse licensed pharmacies for compensable prescribed drugs furnished to eligible MA recipients.
(c) The provision of all nonlegend drugs furnished by a facility to its MA recipients shall be based on a physician’s written order or prescription, be administered judiciously, and be limited to those that are medically necessary for the patient.
(d) Medically needy MA recipients are not eligible to receive prescription drugs under the MA Program. Therefore, these recipients must use their own funds to purchase drugs. If the facility acts as an agent for its MA recipients in purchasing drugs, the facility shall act as a prudent buyer.
(e) Facilities may not solicit or receive a remuneration, directly or indirectly, in cash or in kind, from a person in connection with the furnishing of drugs or in connection with referring a recipient to a person for the furnishing of drugs.
(f) A cost related to a pharmacy consultant shall be shown under general administration expenses on the cost report and will be included under the general administration allowance.
Source The provisions of this § 1181.257 adopted August 5, 1983, effective July 1, 1983, 13 Pa.B. 2402.
Cross References This section cited in 55 Pa. Code § 1181.257a (relating to clarification of the term ‘‘written’’—statement of policy).
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