N.Y. Comp. Codes R. & Regs. Tit. 10 § 85.22 - Maximum reimbursable price and limitations on reimbursement for non-prescription drugs
Pursuant to section 365-a of the Social Services Law, the amount which may be reimbursed for those nonprescription drugs specified in this Part by the commissioner as a reimbursable item of medical assistance shall be the lower of:
(a) the
provider's usual and customary price to the general public on the date of
provision of service, but not to exceed the lower sale price, if any, in effect
on that date;
(b) the maximum
reimbursable price established and maintained by the commissioner; or
(c) reimbursement shall not be available
under the medical assistance program for any nonprescription drug in the
following categories:
(1) a drug regularly
supplied as an integral part of a medical care program activity to a Medicaid
recipient by private, voluntary or public agencies such as the Veterans
Administration, Department of Health and Human Services, State Department of
Health or other funded programs;
(2) any drug for which there are low-cost
alternatives if purchased by a Medicaid recipient, either nonprescription or
prescription drugs;
(3) any drug
considered ineffective in accordance with standards developed by the Food and
Drug Administration;
(4) any drug
sold after the expiration date printed on the container label; and
(5) any drug in a container whose expiration
date has been altered, mutilated, destroyed, obliterated or removed by means of
an affixed price sticker or other change.
Notes
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