Ill. Admin. Code tit. 89, § 140.443 - Filling of Prescriptions
a) The
prescription must contain the information required under Section 3(e) of the
Pharmacy Practice Act of 1987 [
225
ILCS 85/3(e) ], 68 Ill. Adm. Code
1330 and 42 USC 1936(i)(23) and also contain the prescriber's:
1) Drug Enforcement Administration (DEA)
Number; or
2) National Provider
Identifier (NPI); or
3) Medical
Assistance Program Provider Number; or
4) Illinois State License Number.
b) To the extent required by
federal law, effective with new prescriptions executed on or after April 1,
2008, for clients covered under Title XIX of the Social Security Act, a
non-electronic prescription must be written on a tamper-resistant prescription
pad to be eligible for reimbursement. This requirement applies to all
prescriptions regardless of whether the Department is the primary payor.
1) Non-electronic prescriptions are
prescriptions that are not transmitted from the prescriber to the pharmacy via
telephone, telefax, electronic prescribing (e-prescribing) mechanism, or other
means of electronic transmission.
2) Effective April 1, 2008, a prescription
form is considered tamper-resistant when it contains any of the following
characteristics and, effective October 1, 2008, to be considered
tamper-resistant, a prescription form must contain all of the following
characteristics:
A) one or more
industry-recognized features designed to prevent unauthorized copying of a
completed or blank form;
B) one or
more industry-recognized features to prevent the erasure or modification of
information written on the prescription by the prescriber;
C) one or more industry-recognized features
designed to prevent the use of counterfeit prescription forms.
3) If a patient presents at a
pharmacy with a prescription written on a prescription pad that is not
tamper-resistant, and the pharmacist contacts the prescriber via telephone,
telefax, or other electronic communication device, and the prescriber or the
prescriber's agent verifies the validity of the prescription, the prescription
is then considered "electronic" and, therefore, exempt from the requirement
that the prescription be written on a tamper-resistant pad. In such cases, the
pharmacist shall note on the original prescription that the prescriber was
contacted and the prescriber or the prescriber's agent verified the validity of
the prescription.
4) If a patient
presents at a pharmacy with a non-electronic prescription written on a pad that
is not tamper-resistant, and the pharmacist is unable to contact the prescriber
or the prescriber's agent to verify the validity of the prescription, and the
pharmacist's professional judgment determines that not filling the prescription
poses a health risk to the patient, the pharmacist may fill the prescription
and the Department will reimburse for the prescription, provided that the
patient is eligible for coverage of the drug and provided that the drug is
covered by the Department. The pharmacist must obtain from the prescriber or
the prescriber's agent a verbal, faxed, electronic or compliant written
prescription within 72 hours after the date on which the prescription was
filled.
c) Pharmacies
shall not accept blank, presigned prescription forms.
d) If a drug is available by generic name and
the identical drug is prescribed by trade name, payment will be based on cost
of the generic product unless prior authorization has been obtained for
reimbursement based upon the innovator product, or unless the Department
determines that the innovator product, reimbursed at the brand name pricing
methodology, is more cost-effective than the generic equivalent.
e) The Department shall not pay for dispensed
items in excess of the maximum quantity established by the Department, unless
prior approval has been granted to dispense an amount in excess of the
maximum.
f) The Department shall
pay for refills only if the prescribing practitioner authorized refills on the
original prescription in accordance with State law.
g) Pharmacies may use a unit dose system in
the dispensing of drugs when such a system is in compliance with all applicable
State and federal laws. The total quantity dispensed on one prescription cannot
exceed the quantity prescribed or the maximum allowable quantity.
h) Effective January 1, 2013, brand-name,
solid, oral drugs dispensed to clients residing in any facility that provides
medical group care services as defined in Section
140.500,
except Intermediate Care Facilities for the Developmentally Disabled (ICF/DD),
must be dispensed in 14-day supplies. Exceptions: Solid oral doses of
antibiotics and drugs that are dispensed in their original container as
indicated in the Food and Drug Administration Prescribing Information or are
customarily dispensed in their original packaging to assist patients with
compliance (for example, oral contraceptives), may be dispensed in supplies for
greater than 14 days.
Notes
Amended at 37 Ill. Reg. 10282, effective June 27, 2013
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