Cal. Code Regs. Tit. 22, § 53214 - Pharmaceutical Services and Prescribed Drugs
(a) Each plan shall provide, either directly
or through subcontracts, the services of pharmacies and pharmacists. Such
pharmaceutical services shall be available to members during reasonable hours
as specified in the contract.
(b)
Prescribed drugs shall be provided to members in accordance with all applicable
laws and regulations.
(c)
Pharmaceutical services shall include as a minimum the following functions:
(1) Supervising the efficient distribution of
drugs.
(2) Providing pharmaceutical
consultative services when appropriate, which are:
(A) Consultation with members concerning drug
therapy in which the pharmacist asks the member if he is currently taking any
drugs, and informs him on what is being taken, how to take it, what to expect,
what special precautions should be observed and how the medication is to be
properly stored. The purpose of this consultation is to assure that the member
understands the proper use of the drug and that the prescriber's intentions
will materialize in a drug regimen of optimal effectiveness, safety and
duration.
(B) Professional
consultation with prescribers, or other members of the health care team, in
which the pharmacist discusses drug effects, dosage regimens, interactions,
side effects, toxicities, antidotes, drugs of choice for disease conditions and
in all other ways acts as the drug information specialist to the health care
team.
(3) Participating
in in-service training programs for plan staff to provide current information
about pharmaceuticals and their proper use in member treatment.
(4) Participating in drug utilization review.
This shall include a review of:
(A) Member
medical records to determine the range and types of drugs taken by members,
and
(B) Drug utilization patterns
of the plan in general.
(5) Participating in professional review
activities relating to the use of pharmaceuticals.
Notes
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