Section 29-2704. BRAND NAME DRUGS

2704.1A prescription drug written under its brand or trade name shall be filled with its generic equivalent when one is commercially available unless:

(a)The prescriber has indicated that the brand name drug is medically necessary for the beneficiary by writing “medically necessary” or “brand necessary” on the face of the prescription order for the drug; or

(b)The brand is preferred on the District’s Medicaid Preferred Drug List.

2704.2The Department of Health Care Finance (DHCF) or its agent has the authority to verify the medical necessity of a requested brand name drug. 

 

authority

The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code § 1-307.02 (2006 Repl. & 2011 Supp.)) and section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2008 Repl.)).

source

Notice of Final Rulemaking published at 59 DCR 2298, 2302 (March 23, 2012)