Lawriter - OAC - 5160-9-09 Pharmacy services: co-payments.

5160-9-09 Pharmacy services: co-payments.

(A) Adults eligible for the medicaid program will pay a three dollar co-payment for prescribed drugs that require prior authorization and a two dollar co-payment for selected trade name prescribed drugs as indicated in the list specified in paragraph (C) of rule 5160-9-03 of the Administrative Code.

(B) Rules 5160-1-09 and 5160-1-60 of the Administrative Code establish additional requirements regarding co-payments.

(C) Rule 5160-1-09 of the Administrative Code establishes exceptions to the requirement that an individual pay a co-payment.

(D) The exception established in paragraph (C)(4) of rule 5160-1-09 of the Administrative Code regarding emergency services does not extend to drugs prescribed to an individual during a visit to a hospital, clinic, office, emergency department, or other provider setting, that are intended to be used by the individual outside of the provider setting.

(E) No provider of pharmacy services may deny a prescribed drug to an individual eligible for medicaid coverage because the individual is unable to pay the co-payment. The provisions of paragraph (B) of rule 5160-1-09 of the Administrative Code apply to co-payments for prescribed drugs dispensed by a provider eligible to be paid for pharmacy services.

Replaces: 5160-9-09

Effective: 4/1/2017
Five Year Review (FYR) Dates: 04/01/2022
Promulgated Under: 119.03
Statutory Authority: 5162.20, 5164.02
Rule Amplifies: 5162.03, 5162.20, 5164.02
Prior Effective Dates: 1/1/04, 1/1/06, 2/1/10