Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 10 - PHARMACEUTICAL SERVICES
Section 10-3 - Definitions

(a) "AB Rated." An "AB rated" generic drug product is one that the FDA has determined to be bioequivalent to a branded drug. A generic drug is considered bioequivalent to a branded drug if it contains the same active pharmaceutical ingredient as the branded drug and there is no significant difference in the formulation, quality, and effectiveness of the two (2) drugs.

(b) "Average wholesale price (AWP)." A national average of list prices charged by wholesalers to pharmacies.

(c) "Board of Pharmacy." The Wyoming State Board of Pharmacy, its agent, designee or successor.

(d) "Brand name." The proprietary or trade name selected by the manufacturer, given to a drug, and placed upon a drug, its container, label, or wrapping at the time of packaging.

(e) "Compound Drug." A drug prepared by a pharmacist who mixes or adjusts drug ingredients to customize a medication to meet a patient's individual needs.

(f) "Device." Any article or healthcare product intended for use in the diagnosis of disease or other condition or for use in the care, treatment, or prevention of disease that does not achieve any of its primary intended purposes by chemical action or by being metabolized.

(g) "Drug Efficacy Study Implementation (DESI) drugs." Drugs determined by the United States Food and Drug Administration (FDA) to be less than effective. This definition applies to all drugs that are similar, related, or identical to these drugs pursuant to FDA designation. Compound formulations which contain a DESI drug are considered to be DESI compounds/DESI drugs.

(h) "Drug Utilization Review (DUR) requirements." The Drug Utilization Review Requirements as set forth in Chapter 9 of the Board of Pharmacy Rules and 42 C.F.R. Part 456. A DUR program shall include prospective drug review, retrospective drug use review, and an educational program.

(i) "Federal Upper Limit (FUL)." The maximum amount the federal government (Centers for Medicare and Medicaid Services) will pay for multiple source drugs.

(j) "Food and Drug Administration (FDA)." The Food and Drug Administration of the United States of America, its agent, designee, or successor.

(k) "Local Trade Area." The geographic area surrounding the client's residence, including portions of states other than Wyoming, commonly used by other persons in the same area to obtain pharmaceutical services.

(l) "Gross Amount Due (GAD)." The sum of the submitted product component cost and the dispensing fee submitted by the pharmacy on a prescription claim.

(m) "Ingredient Cost Submitted." The product cost submitted by the pharmacy on a prescription claim.

(n) "Maintenance drug." A covered prescription drug prescribed for a chronic condition (i.e., diabetes, arthritis, high blood pressure, or heart conditions).

(o) "Multiple source drug." A drug marketed or sold by two (2) or more manufacturers or labelers or a drug marketed or sold by the same manufacturer or labeler under two (2) or more different proprietary names.

(p) "National Average Drug Acquisition Cost (NADAC)." A drug price point that is calculated based on average pharmacy acquisition cost of a particular drug.

(q) "National drug code (NDC)." The code number determined for and assigned to a drug by the FDA.

(r) "One month supply." The quantity of drugs sufficient to last up to thirty-four (34) days.

(s) "Pharmaceutical service." Drugs, devices or medical supplies that are covered services, as defined in this Chapter.

(t) "Pharmacist." A person licensed to practice pharmacy by the Wyoming State Board of Pharmacy or a similar board or agency in another state.

(u) "Pharmacy Therapeutics (P&T) Committee." An advisory committee that shall review evidence based research and provide recommendations to the Department as to the clinical effectiveness of a service or medication within a therapeutic drug class.

(v) "Preferred Drug List (PDL)." A list of preferred pharmaceutical substances for selected pharmacologic or therapeutic classes that is maintained by the Department, is designed to maximize clinical and economic outcomes, and is incorporated herein by reference.

(w) "Prescription drug." A drug that is:

(x) "Wholesale Acquisition Cost (WAC)." The list price paid by a wholesaler, distributor and other direct accounts for drugs purchased from the wholesaler's supplier not including discounts or rebates.

(y) "Wholesaler." An individual or entity that furnishes drugs, medical supplies, or both, to pharmacies or pharmacists.