§ 25.5-5-505 — Prescribed drugs - mail order - rules

(1) (a) (I) The state board
shall adopt by rule a system to allow medical assistance recipients the option to
receive through the mail prescribed maintenance medications used to treat chronic
medical conditions.

(II) The state board rules must include the definition of maintenance
medications. The rules may allow a medical assistance member to receive through
the mail up to a three-month supply, or the maximum allowed under federal law, of
maintenance medications used to treat chronic medical conditions.

(b) To the extent allowed by federal law, the state department shall require
that a medical assistance member receiving prescription medication through the
mail pay the same copayment amount as a medical assistance member receiving
prescription medication through any other method. The state department shall
encourage medical assistance members who choose to receive maintenance
medications through the mail to use local retail pharmacies for mail delivery.

(c) A pharmacy may provide maintenance medications through the mail to
medical assistance recipients in accordance with all applicable state and federal
laws if the pharmacy is enrolled as a provider with the state department and is
registered with the state board of pharmacy, created and existing pursuant to
section 12-280-104.

(d) A nonresident prescription drug outlet doing business in this state shall
provide a means for recipients of state medical assistance who have third-party
insurance with whom the nonresident prescription drug outlet has a contractual
relationship to receive their required pharmacy benefits at a cost to the recipients
of no more than the legally allowed state medical assistance copayment. If a third-party insurance carrier's copayment or deductible for pharmacy benefits is larger
than the legally allowed state medical assistance copayment, the prescription drug
outlet may bill the state medical assistance program for the difference pursuant to
state medical assistance reimbursement rules.

(1.5) The state department shall publish on its website and include in the
member handbook the following information for members enrolled in fee-for-service medical assistance programs:

(a) That a medical assistance member may use the pharmacy of the
member's choice;

(b) That a medical assistance member may use a local retail pharmacy for
mail delivery of maintenance medications, if offered; and

(c) That the copayment amount for prescription medications is the same at
any pharmacy enrolled in the medical assistance program.

(2) The state department shall seek any federal authorization necessary to
implement this section.

Legislative History

Source: L. 2006: Entire article added with relocations, p. 1905, � 7, effective July 1. L. 2008: (1) amended, p. 890, � 1, effective May 20. L. 2009: (1)(a)(I)(B) amended, (SB 09-252), ch. 271, p. 1228, � 1, effective May 18. L. 2016: (1) amended and (1.5) added, (SB 16-027), ch. 208, p. 745, � 1, effective August 10. L. 2019: (1)(c) amended, (HB 19-1172), ch. 136, p. 1710, � 187, effective October 1. L. 2024: (1)(a)(II), (1)(b), and (1.5) amended, (SB 24-176), ch. 152, p. 658, � 66, effective August 7.