173.803 Prohibiting payment of certain claims.

The department of aging may not make a payment under section 173.801 of the Revised Code for a claim submitted under section 173.80 of the Revised Code if any of the following are the case:

(A) The claim is submitted by either a terminal distributor of dangerous drugs that is not a participating terminal distributor or a drug mail order system that is not the system included in the Ohio’s best Rx program pursuant to section 173.78 of the Revised Code.

(B) The claim is for a drug that is not included in the program.

(C) The claim is for a drug included in the program but the drug is dispensed to an individual who is not covered by an Ohio’s best Rx program enrollment card.

(D) A person or government entity has paid the participating terminal distributor or the program’s drug mail order system through any other prescription drug coverage program or prescription drug discount program for dispensing the drug, unless the payment is reimbursement for redeeming a coupon or is an amount directly paid by a drug manufacturer to the distributor or system for dispensing drugs to residents of a long-term care facility.

Effective Date: 07-01-2007