Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 1032 (February 24, 2024).

55 Pa. Code § 6211.77. Cost of drug services.

§ 6211.77. Cost of drug services.

 (a)  Detailed and itemized documentation of the claimed expense must be maintained in order for drug services to be allowable.

 (b)  Drug services costs are allowable for nonlegend drugs such as laxatives, aspirin, and antacids if the drugs are provided directly to the resident from the facility’s own drug supply.

 (c)  The provision of nonlegend drugs by a facility to its medical assistance clients shall be based on a physician’s written order or prescription, be administered judiciously, and be limited to those that are medically necessary for the client.

 (d)  Costs related to legend drugs for which payment will be made under the MA Program to an enrolled pharmacy or costs related to legend drugs that are noncompensible under the MA Program are not considered as allowable costs for a facility. The Department will directly reimburse licensed pharmacies for compensable prescribed drugs furnished to eligible medical assistance clients.

 (e)  Medically needy residents are not eligible to receive prescription drugs under the MA Program. If the facility acts as an agent for residents in purchasing drugs, the facility shall act as a prudent buyer.

 (f)  The facility shall not solicit or receive any remuneration directly or indirectly in cash or in kind from a person in connection with the furnishing of drugs or in connection with referring a recipient to a person for the furnishing of drugs.

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