Section 29-2709. REIMBURSEMENT FOR BRAND NAME DRUGS

 

2709.1Methods for determining costs of single source drugs are:

(a) The costs for prescribed drugs which shall not exceed the WAC, plus three percent (3%), if available;

 

(b) The costs for drugs that do not have a WAC shall be priced based on the direct price benchmark plus three percent (3%) as evaluated by DHCF using a national standard database; and

 

(b)   The cost for the WAC which shall be the price, at the time of service, obtained from a nationally recognized comprehensive data file maintained by a vendor under contract with DHCF.

 

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, 2306 (March 23, 2012).