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 D.C. Municipal Regulations (Last Updated: September 13, 2017)
 Title 29. PUBLIC WELFARE
 Chapter 29-27. MEDICAID REIMBURSEMENT FOR FEE FOR SERVICE PHARMACY SERVICES

  Section 29-2707. REQUIREMENTS FOR RETURNED TO STOCK PRESCRIPTIONS  

Latest version.

  • 2707.1All new and refilled prescriptions that have been filled for Medicaid beneficiaries but not picked up from the pharmacy within fourteen (14) days from the date of fill shall be returned to stock by the provider. The claim shall be reversed by the pharmacy benefit manager.

     

    2707.2The following standards shall be followed for prescriptions returned to stock due to lapse of the time requirements set forth in § 2702.1:

     

    (a) All medications returned to stock shall have originated at the same pharmacy to assure chain of custody;

     

    (b) A registered pharmacist shall assure that the medications have been stored in accordance with manufacturers’ recommendations and current United States Pharmacopeia USP standards compendia;

     

    (c)    Medications that have been reconstituted or compounded shall not be returned to stock but appropriately disposed of according to store policy; and

     

    (d) A licensed pharmacist shall confirm that all controlled substance prescriptions are returned to stock to minimize opportunities for tampering and diversion.

    2707.3Failure to reverse Medicaid prescription claims when such prescriptions are returned to stock may result in fraudulent and negligent health care billing.  DHCF may at any time audit pharmacies to monitor such activity and seek repayment of any overpayment to provider pharmacies.

     

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, 2304 (March 23, 2012).