Arizona Administrative Code
Title 9 - HEALTH SERVICES
Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION
Article 2 - SCOPE OF SERVICES
Section R9-22-209 - Pharmaceutical Services
Universal Citation: AZ Admin Code R 9-22-209
Current through Register Vol. 30, No. 38, September 20, 2024
A.An inpatient or outpatient provider, including a hospital, clinic, other appropriately licensed health care facility, and pharmacy may provide covered pharmaceutical services.
B.The Administration or a contractor shall require a provider to make pharmaceutical services:
1. Available during customary business hours,
and
2. Located within reasonable
travel distance of a member's residence.
C.Pharmaceutical services are covered if:
1. Prescribed for a member by the member's
primary care provider, attending physician, practitioner, or dentist;
2. Prescribed by a specialist upon referral
from the primary care provider or attending physician; or
3. The contractor or its designee authorizes
the service.
D.The following limitations apply to pharmaceutical services:
1. A medication personally dispensed by a
physician, dentist, or a practitioner within the individual's scope of practice
is not covered, except in geographically remote areas where there is no
participating pharmacy or if accessible pharmacies are closed.
2. A new prescription or refill in excess of
a 30 day supply is not covered unless:
a. The member will be
out of the provider's service area for an extended period of time and the
prescription is limited to the extended time period, not to exceed a 90 day
supply.; or
b. The Contractor
authorizes the prescription for an extended time period not to exceed a 90-day
supply.
3. An
over-the-counter medication, in place of a coveredprescription medication, is
covered only if the over-the-counter medication is appropriate, equally
effective, safe,and less costly than the covered prescription
medication.
E. A contractor shall monitor and ensure sufficient services to prevent any gap in the pharmaceutical regimen of a member who requires a continuing or complex regimen of pharmaceutical treatment to restore, improve, or maintain physical well being.
Disclaimer: These regulations may not be the most recent version. Arizona may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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