173-71-04 Drug mail-order system.

(A) For purposes of making drugs included in the best Rx program available to any participant by mail, ODA shall include one drug mail-order system within the program.

(B) ODA shall not promote the purchase of drugs through the drug mail-order system by using information collected under the program regarding the drugs purchased by participants from participating pharmacies. In accordance with division (D)(2) of section 173.90 of the Revised Code, the drug mail-order system may solicit, disclose, receive, or use identifying information or knowingly permit the use of identifying information to the extent required or permitted by ODA, except that it may not promote the purchase of drugs through the drug mail-order system by using information collected under the program regarding the drugs purchased by participants from participating pharmacies.

(C) Annually, ODA shall establish a base price for each drug included in the best Rx program that is dispensed by the drug mail-order system by using one or more formulas designated under paragraph (C) of rule 173-71-07 of the Administrative Code. Whenever a drug is dispensed through the drug mail-order system, the drug mail-order system shall charge a participant the base price plus the administrative fee specified by rule 173-71-07.2 of the Administrative Code, so long as the total price of a given drug is not more than the amount that is charged for the same quantity of the same drug dispensed by a participating pharmacy. In accordance with division (A)(5) of section 173.75 of the Revised Code, the drug mail-order system may not charge a participant a professional fee.

(D) In accordance with division (B) of section 173.773 of the Revised Code, each time a drug is purchased through the drug mail-order system and the participant’s program identification number is available, the participant shall present the identification number as confirmation of enrollment. Otherwise, the drug mail-order system shall confirm the individual’s enrollment through ODA.

(E) The drug mail-order system shall submit a claim to ODA for every drug sold to a participant through the drug mail-order system pursuant to section 173.80 of the Revised Code and rule 173-71-08 of the Administrative Code.

(F) The drug mail-order system shall maintain and safeguard all hard-copy or electronic records related to the best Rx program throughout the period of its contract with the administrator and for no less than six years following the termination of the contract with the administrator or until the resolution of any outstanding audit or investigation, whichever is later.

(G) The drug mail-order system shall comply with requests for information from ODA.

(H) The drug mail-order system shall collect the administrative fee specified by rule 173-71-07.2 of the Administrative Code. If the amount of the program administrative fees collected exceeds the amount of manufacturer payments owed in any quarter, as determined by ODA, the drug mail-order system shall reimburse the best Rx program fund for the amount of overpayment or accept a reduction in the amount of future manufacturer payments.

Replaces: pt 5101:13-1-06

Effective: 10/04/2007

R.C. 119.032 review dates: 08/31/2011

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.83

Rule Amplifies: 173.773, 173.78, 173.80, 173.832

Prior Effective Dates: 11/1/2004, 4/4/07 (Emer.), 7/5/07 (Emer.)