Section 29-2005. PAYMENT FOR DRUGS

 

2005.1The program shall make full payment for an eligible drug for uninsured persons and full payment up to the amount of an insurance co-payment required of persons who are insured.

 

2005.2No person shall be entitled to any payment under this program if no appropriated funds are available for that purpose.

 

2005.3Prescriptions for an eligible drug may be filled by any pharmacy currently enrolled as a provider in the District of Columbia Medicaid Program.

 

2005.4A pharmacy filling a prescription for an eligible drug for an individual covered under this program shall submit the claim for payment to the Office of Health Care Financing, using the same form and following the same procedures as if the claim were being filed for drugs furnished to a District of Columbia Medicaid recipient.

 

2005.5The Administration for HIV Policy and Programs shall seek reimbursement from the patient's insurance carrier or other third-party sources providing reimbursement of any amount chargeable to the carrier or third-party payor.

 

2005.6A pharmacy filling a prescription for an eligible drug for an individual covered under this program shall be paid the actual wholesale price of the drug, as determined by the Office of Health Care Financing, plus a dispensing fee of four dollars and twenty-five cents ($4.25) for each prescription filled.

 

source

Final Rulemaking published at 36 DCR 4935, 4938 (July 14, 1989); as Final Rulemaking published at 54 DCR 2360 (March 16, 2007).