X hits on this document

526 views

0 shares

0 downloads

0 comments

17 / 147

  • D.

    STATES' PROHIBITION ON SUBSTITUTION AND MANDATED COST SAVINGS

    • 47.

      State Food and Drug Acts, Pharmacy Acts, and Medicaid laws prohibit drug

substitutions and institute safeguards for cost savings in their Medicaid programs. All states

prohibit filling a prescription with any drug other than the one prescribed. For example, the

Illinois Food and Drug Act prohibits "[d]ispensing or causing to be dispensed a different drug in

place of the drug or brand of drug ordered or prescribed without the express permission of the

person ordering or prescribing." 410 ILCS 620/3 and 3.14.1

48.

State laws also encourage, and often require. that drugs be provided economically

to prevent providers from choosing drugs that are more expensive for payors when there are Jess

costly alternatives. For example, in a narrow exception to the prohibition against substituting

drugs, states allow generic drugs to be substituted for brand name equivalents when the generic

drug is cheaper.

49.

In addition, practically every state more broadly requires that Medicaid providers

furnish

services

economically.

The

requirement

that

the

provider

be

accountable

for

the

economic effect of its conduct on the state Medicaid program can appear in the state Medicaid

statutory sections, regulatory sections, or in the provider manuals. States generally require that

the provider assert its compliance with these Medicaid rules as a condition of participation or

payment.

50.

In Florida, for example,

"medically necessary" goods or services must "[b]e

reflective of the level of service that can be safely furnished, and for which no equally effective

J See also, e.g., Florida, Fla. Stat. §465.016(l)(g) (Prohibiting furnishing upon prescription, an ingredient or m1icled different in any manner from the ingredient or article prescribed); Delaware, Del. Code tit. 24 §2553(a) (Prohibiting substitution of anything "other or different from the drug, medicine, chemical or preparation for medicinal use, recognized or authorized by the latest edition of the United States PharmacopoeialNational Formulary, or prepared according to the private formula of some individual or finn, ordered or called for by such person, or called for in a physician's prescription."); Pennsylvania, 55 Pa Code §1121.52(c) (Changes in the nature or brand, strength, directions, or quantity of a drug are acceptable only with prior prescriber consent).

13

Document info
Document views526
Page views526
Page last viewedWed Dec 07 08:57:37 UTC 2016
Pages147
Paragraphs7751
Words41508

Comments