DAR File No. 29961

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-60

Medicaid Policy for Pharmacy Copayment Procedures

FIVE-YEAR NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

DAR File No.: 29961
Filed: 05/21/2007, 04:01
Received by: NL

NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

Concise explanation of the particular statutory provisions under which the rule is enacted and how these provisions authorize or require the rule:

Section 26-18-105 authorizes the Division to establish and administer a drug prior approval program. 42 CFR 447.331 authorizes the Division to establish pharmacy policy for reimbursement of covered, prescribed, outpatient drugs dispensed to eligible Medicaid clients. 42 CFR 447.15 and 447.50 authorize the Division to establish copayment policy for clients who are not federally exempt from copayment requirements.

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

No written or oral comments have been received regarding this rule.

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

This rule is necessary because it establishes Medicaid policy for pharmacy services that include eligibility, access, coverage, limitations, copayment, and reimbursement. This rule serves as an important utilization review and cost saving tool. Therefore, this rule should be continued.

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

Direct questions regarding this rule to:

Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Authorized by:

David N. Sundwall, Executive Director