Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 10 - PHARMACEUTICAL SERVICES
Section 10-14 - Copayment

Universal Citation: WY Code of Rules 10-14

Current through September 21, 2024

(a) Clients shall pay a three dollar and sixty-five cent ($3.65) per prescription copayment for Brand Name drugs, or a sixty-five cent ($0.65) per prescription copayment for multiple source drugs, except as specified in subsection (b).

(b) Exemptions. The following clients and pharmaceutical services are exempt from the copayment requirement:

(i) Residents of a nursing facility or swing beds;

(ii) Family planning products;

(iii) Pregnant clients;

(iv) Clients under age twenty-one (21) years;

(v) American Indians and Alaska Natives;

(vi) Emergency Services;

(vii) Hospice Services; and

(viii) Vaccine products administered in the pharmacy.

(c) Notification of copayment amount. The Department shall notify providers of the copayment amount by means including, but not limited to, manuals, bulletins, facsimiles, or designated websites. The Department shall notify clients by bulletin or other means of communication designated by the Department.

(d) Collection of copayment. Providers are responsible for collecting the copayment. The amount of the copayment shall be automatically deducted by the Department from the Medicaid allowable payment, regardless of whether the copayment is actually collected.

(e) Denial of services. A provider may not deny pharmaceutical services to a client because of the client's inability to make the copayment, except when a client regularly refuses to make copayments.

(i) For purposes of this Section, a client who refuses to make a copayment two (2) or more times has "regularly refused" to make copayments.

Disclaimer: These regulations may not be the most recent version. Wyoming 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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