Section 140.447  Reimbursement

a)         The calculation of average wholesale price in the determination of the Department's maximum price (Section 140.445(b)) is made using the standard package size.

b)         If a pharmacy gives discounts to the general public, it must provide the same to Public Aid recipients.  If discounts are allowed only to a specific group of people, they shall be extended to a recipient if he or she is a member of the special discount group.  Public Aid recipients can constitute a special group and receive a discount, but they cannot be excluded from a discount group just because they are recipients.

c)         The Department will require pharmacies to complete hard copy (paper) claim forms for pharmacy services and attach a Prescribing Practitioner Name Identification Form.  A separate hard copy (paper) claim form and Practitioner Name Identification Form is to be required for each recipient and prescribing practitioner.

d)         The Department will authorize an exception for pharmacies, to the requirements of subsection (c) of this Section, by allowing pharmacy claims to be submitted with the prescribing practitioner's DEA number, Department Medical Assistance Program participating provider identification number or Social Security Number.

(Source:  Amended at 25 Ill. Reg. 14957, effective November 1, 2001)