173-71-05 Participating pharmacy agreement.

(A) Any pharmacy may enter into an agreement with ODA to participate in the best Rx program pursuant to section 173.79 of the Revised Code. In accordance with division (D)(35) of section 127.16 of the Revised Code, any pharmacy may enter into an agreement with ODA without undergoing a competitive selection process.

(B) Before entering into an agreement with a pharmacy, ODA shall provide the pharmacy with one of the following:

(1) A formula that allows the pharmacy to calculate the amount that a participating pharmacy shall charge a participant for each drug included in the best Rx program, in accordance with division (A)(1) or (A)(2) of section 173.75 of the Revised Code;

(2) A statistically valid sampling of drug prices that includes the amount that a participating pharmacy shall charge a participant in accordance with division (A)(1) or (A)(2) of section 173.75 of the Revised Code for not fewer than two brand name drugs and two generic drugs from each category of drugs included in the best Rx program; or,

(3) The current amount that a participating pharmacy shall charge a participant for each drug included in the best Rx program, in accordance with division (A)(1) or (A)(2) of section 173.75 of the Revised Code.

(1) Except as provided in paragraph (C)(3) of this rule, remain in effect for not less than one year;

(2) Specify the date that the agreement begins and the date that the agreement ends;

(3) Permit the participating pharmacy to terminate the agreement before the date the agreement would otherwise end as specified pursuant to paragraph (C)(2) of this rule by providing ODA notice of early termination at least thirty days before the effective date of the early termination;

(4) Require the participating pharmacy to make best Rx applications and program information available to customers;

(5) Each time a drug is purchased under the program, require the participating pharmacy to confirm whether the individual for whom the drug is dispensed is enrolled in the best Rx program, in accordance with division (B) of section 173.773 of the Revised Code. If the participant’s enrollment card is available for presentation at the time of the purchase, the participant shall present the card to the participating pharmacy as confirmation of the participant’s enrollment in the program. Otherwise, the participating pharmacy shall confirm the individual’s enrollment through the ODA;

(6) Require the participating pharmacy to offer general drug counseling to the participant for every drug dispensed to the participant in accordance with division (B)(4) of section 4729.01 of the Revised Code;

(7) Require that the participating pharmacy comply with section 173.75 of the Revised Code when charging for a drug purchased under the best Rx program;

(8) Permit the participating pharmacy to add to the amount to be charged under division (A)(1) or (A)(2) of section 173.75 of the Revised Code a professional fee in an amount established by rule 173-71-07.1 of the Administrative Code;

(9) Require the participating pharmacy to add to the amount to be charged under division (A)(1) or (A)(2) of section 173.75 of the Revised Code 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, and as determined by ODA, the participating pharmacy shall reimburse the best Rx program fund for the amount of overpayment or accept a reduction in the amount of future manufacturer payments;

(10) Require the participating pharmacy to disclose to each participant the amount the participant saves under the program as determined in accordance with section 173.752 of the Revised Code;

(11) Require the participating pharmacy to submit a claim to ODA under section 173.80 of the Revised Code for each sale of a drug included in the best Rx program to a participant;

(12) Permit the participating pharmacy to deliver drugs to participants by mail, but not by using a drug mail-order system that operates in the same manner as the drug mail-order system included in the best Rx program pursuant to section 173.78 of the Revised Code;

(13) Require the participating pharmacy to maintain and safeguard all hard-copy or electronic records related to the best Rx program during the term of the agreement and for no less than six years following the termination of the agreement or until the resolution of any outstanding audit or investigation, whichever is later;

(14) Permit the participating pharmacy to solicit, disclose, receive, or use identifying information or knowingly permit the use of identifying information for the purpose of increasing participation by individuals in the best Rx program, in accordance with division (D)(1) of section 173.90 of the Revised Code; and,

(15) Require the participating pharmacy to comply with requests for information by ODA.

(D) In accordance with section 173.791 of the Revised Code, no program or network of health care providers shall prohibit the participation of a pharmacy in that program or network of health care providers on the basis that the pharmacy has not entered into a participating pharmacy agreement under section 173.79 of the Revised Code to participate in the best Rx program.

Replaces: pt 5101:13-1-05

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, 173.79, 173.791, 173.90

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