Administrative Rules of Montana
Department 24 - LABOR AND INDUSTRY
Chapter 24.29 - WORKERS' COMPENSATION AND OCCUPATIONAL DISEASE
Subchapter 24.29.15 - Nonfacility Service Rules
Rule 24.29.1529 - PRESCRIPTION DRUGS FEE SCHEDULE
Universal Citation: MT Admin Rules 24.29.1529
Current through Register Vol. 18, September 20, 2024
(1) In addition to the limitations on the payments for and dispensing of prescription drugs as set out by 39-71-727, MCA, the following apply:
(a) The
reimbursement rate for prescription drugs is based upon the rate in effect on
the date the drug is dispensed.
(b)
Reimbursement rates to retail pharmacies for brand-name drugs are limited to
the lesser of:
(i) the price charged for the
prescription drug at the time of dispensing; or
(ii) the average wholesale price (AWP), minus
10 percent, at the time of dispensing, plus a dispensing fee, not to exceed
$3.00 per prescription drug.
(c) Reimbursement rates to retail pharmacies
for generic-name drugs are limited to the lesser of:
(i) the price charged for the prescription
drug at the time of dispensing; or
(ii) the AWP, minus 25 percent, at the time
of dispensing, plus a dispensing fee, not to exceed $3.00 per prescription
drug.
(d) For the
purposes of this rule, average wholesale prices must be updated
monthly.
(2) If, prior to liability for a claim being accepted by the insurer, an injured worker has personally paid for prescription drugs, prescribed for a condition for which liability is subsequently accepted, the injured worker is entitled to a refund of the price paid by the injured worker for the prescription drug.
(a) The insurer, when accepting liability for
a condition for which a prescription drug has been prescribed, must, upon
receiving a proper receipt, reimburse the injured worker the retail price
paid.
(b) After the injured worker
has been reimbursed by the insurer, the pharmacy must, upon request by the
insurer, reimburse the insurer for the difference in the amount paid by the
injured worker and the amount provided by the fee schedule.
39-71-203, MCA; IMP, 39-71-727, 39-71-743, MCA;
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