Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 140 - MEDICAL PAYMENT
Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES
Section 140.414 - Requirements for Prescriptions and Dispensing of Pharmacy Items - Prescibers
Universal Citation: 89 IL Admin Code ยง 140.414
Current through Register Vol. 48, No. 38, September 20, 2024
For the purpose of this Section, "prescriber" shall mean any person who, within the scope of his or her professional licensing requirements, may prescribe or dispense drugs.
a) Prescriptions
1) A prescriber may prescribe
any pharmacy item, not otherwise excluded, that, in the prescriber's
professional judgment, is essential for the diagnosis or accepted treatment of
a recipient's present symptoms. The Department may require prior approval of
any drug except as outlined in Section
140.442(a)(9).
2) A prescriber shall:
A) Use a tamper-resistant prescription form,
as defined at Section
140.443(b)(2),
for non-electronic prescriptions. Non-electronic prescriptions are defined at
Section
140.443(b)(1).
In addition, the prescriber shall ensure the prescription form is compliant
with Section 3(e) of the Pharmacy Practice Act of 1987 [225
ILCS 85/3(e)] , 68 Ill. Adm. Code
1330 and 42 USC 1936(i)(23); and
B)
Enter on the form all data elements required under Section 3(e) of the Pharmacy
Practice Act of 1987 [225
ILCS 85/3(e)] , 68 Ill. Adm. Code
1330 and 42 USC 1936(i)(23), as well as one of the following data elements
identifying the prescriber:
i) Drug
Enforcement Administration (DEA) Number; or
ii) National Provider Indentifier (NPI);
or
iii) Medical Assistance Program
Provider Number; or
iv) Illinois
State License Number.
3) The prescriber shall not charge for
writing a prescription.
4) Items
that shall not be prescribed are listed in Section
140.441.
b) Dispensed Items
1) A participating prescriber may dispense
pharmacy items subject to the Department's coverage policies. The prescriber
shall not charge for any samples dispensed or anesthesia agents administered
for office surgical procedures.
2)
Effective July 1, 2012, the Department shall pay for covered outpatient drug
items dispensed or administered by a non-pharmacy provider at a rate equal to
the lowest of the provider's usual and customary charge to the public; or
A) The Average Sales Price (ASP) plus 6
percent. ASP means the ASP as defined in the Social Security Act, Title XVIII,
section 1847A(c) (
42 USC
1395 w-3a(c)) and calculated by the federal
Centers for Medicare and Medicaid Services (CMMS); or
B) The State upper limit.
3) Effective July 1, 2012, in
cases in which ASP is not available and no State upper limit has been
developed, the Department's lowest maximum allowable price for all covered NDCs
assigned to the HCPCS billing code (the methodology for determining the
Department's maximum prescription prices is specified in Section
140.445(b)(1)
and (b)(2)) .
4) Reimbursement rates for drugs dispensed or
administered by non-pharmacy providers shall be updated no less frequently than
twice per calendar year.
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