173.801 Payment of claims.

(A) In accordance with rules adopted under section 173.83 of the Revised Code and subject to section 173.803 of the Revised Code, the department of aging shall make payments under the Ohio’s best Rx program for complete and timely claims submitted under section 173.80 of the Revised Code for drugs included in the program that are also included in a manufacturer agreement entered into under section 173.81 of the Revised Code. The payment for a complete and timely claim shall be made by a date that is not later than two weeks after the department receives the claim from the participating terminal distributor or the drug mail order system included in the program pursuant to section 173.78 of the Revised Code.

(B) Subject to division (D) of this section, the amount to be paid for a claim for a drug dispensed under the program shall be determined as follows:

(1) Compute the manufacturer payment amount that applies to the transaction, based on quantity of the drug dispensed and the drug’s national drug code number, in accordance with the provisions of division (B) of section 173.812 of the Revised Code;

(2) If rules adopted under section 173.83 of the Revised Code require that program participants be charged an administrative fee for each transaction in which a quantity of the drug was dispensed, subtract from the amount computed under division (B)(1) of this section the administrative fee amount specified in those rules.

(C) The department may combine the claims submitted by a participating terminal distributor or the program’s drug mail order system to make aggregate payments under this section to the distributor or system.

(D) If the total of the amounts computed under division (B) of this section for any period for which payments are due is a negative number, the participating terminal distributor or the program’s drug mail order system that submitted the claims has been overpaid for the claims. When there is an overpayment, the department shall reduce future payments made under this section to the distributor or system or collect an amount from the distributor or system sufficient to reimburse the department for the overpayment.

Effective Date: 07-01-2007