405 IAC 5-24-6 Professional dispensing fee

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.