410 IAC 3.2-7-2 Basic services included in the health care service package

Sec. 2. (a) The availability and provision of health care services included in the basic service component is contingent upon the availability of program funding. (b) The CSHCN program shall pay no greater than the Medicaid rate for any health care services included in the basic service package as defined as follows: (1) Primary care visits conducted by approved providers in accordance with recommendations from the American Academy of Pediatrics. (2) Secondary care visits at approved providers for medically necessary diagnostic and treatment services. (3) Drugs and medications requiring a prescription under Indiana or federal law that are medically necessary for treatment or control of any medical conditions affecting the child. Insulin and insulin syringes shall be provided when prescribed by an approved provider. (4) Immunizations required by Indiana law and administered in accordance with recommendations from the American Academy of Pediatrics and the Centers for Disease Control. (c) The CSHCN program shall provide or pay only for generically equivalent drugs and medications unless a generically equivalent drug or medication is not available or is medically contraindicated. (d) If a prescription is filled under the CSHCN program, the pharmacist shall substitute a generically equivalent drug product if the substitution would result in a lower price unless: (1) the words "Brand Medically Necessary" are written in the practitioner's own writing on the form; or (2) the practitioner has indicated that the pharmacist may not substitute a generically equivalent drug product by orally stating that a substitution is not permitted. (e) If the practitioner orally states that a generically equivalent drug product may not be substituted, the practitioner must subsequently forward to the pharmacist a written prescription with the "Brand Medically Necessary" instruction appropriately indicated in the physician's own handwriting. (f) The brand name of the prescribed drug product may not be included on the prescription container label unless it is the drug product actually dispensed. (g) The pharmacist shall record on the prescription the name of the manufacturer or distributor, or both, of the actual drug product dispensed under this section. (h) The CSHCN program shall not pay for over-the-counter drugs, medications, or supplies. Vitamins, nutritional supplements, and formula shall be provided only when medically necessary for treatment of an eligible medical condition, when these items are not provided through other programs, including, but not limited to, the Special Supplemental Food Program for Women, Infants, and Children (WIC) and when authorized by the director.