Section 29-914. D.C. MEDICAID PRIOR APPROVAL REQUIRED FOR SELECTED PHARMACEUTICALS PROVIDED TO D.C. MEDICAID AMBULATORY CARE PATIENTS

 

914.1Prior authorization from the D.C. Medicaid program shall be required for the dispensing of the following prescribed drugs to D.C. Medicaid ambulatory care patients:

 

(a)Oxycodone HC1 and Aspirin (more commonly known as Percodan);

 

(b)Flurazepam (more commonly known as Dalmane); and

 

(c)Oxycodone and Acetaminophen (more commonly known as Percocet and Tylox).

 

914.2Pharmacists shall request authorization from the Department of Human Services Office of Health Care Financing prior to dispensing to D.C. Medicaid patients any of the prescribed drugs identified in §914.1.

 

914.3For purposes of this section, the phrase “Ambulatory Care Patients” means a patient served through a system of primary care provided through outpatient facilities including services provided to patients who reside in intermediate care facilities for the mentally retarded. Ambulatory care does not include services provided in inpatient hospitals, skilled nursing facilities, intermediate care facilities or health maintenance organizations.

 

authority

The authority for this section is D.C. Code, 2001 Ed. §1-307.02; Commissioner’s Order 70-83 (March 6, 1970), as amended by Mayor’s Order 79-144 (July 11, 1979); and Reorganization Plan No. 2 of 1979, 3 D.C. Code, 2001 Ed. at 338.

source

as amended by Final Rulemaking published at 34 DCR 4400 (July 10, 1987).