ARSD 67:16:14:06. Payment for items dispensed by pharmacy

Payment for items covered under this chapter and dispensed by a pharmacy is made at the lowest of the following: (1) The provider's usual and customary charge; (2) The estimated acquisition cost of the drug dispensed, plus a dispensing fee contained on the department's fee schedule website; (3) The payment limit established by the United States Department of Health and Human Services under the provisions of 42 C.F.R. § 447.332 (July 1, 1987) for multiple-source drugs, plus a dispensing fee contained on the department's fee schedule website; or (4) The payment limit established by the department, in consultation with the contractor, for drugs contained on the state MAC list, plus a dispensing fee contained on the department's fee schedule website. For purposes of this section, the provider's usual and customary charge is that charge made by the provider to third-party payers for a specific item on the day the item is supplied.