Ala. Admin. Code r. 560-X-16-.07
Current through Register Vol. 43, No. 02, November 27, 2024
Section 560-X-16-.07 - Out-Of-State Pharmacies(1) Under State and Federal regulations, a pharmacy must sign an agreement with Alabama Medicaid Agency. However, when a recipient is in another state and requires service, the following procedure has been adopted.(2) Pharmacies Bordering Alabama (a) Pharmacies bordering Alabama may participate in the Alabama Medicaid Program by completing an application for out-of-state pharmacies, and upon certification of the State Board of Pharmacy in that state that the pharmacy is registered and has been issued a permit.(b) The pharmacy must then sign a Pharmacy Vendor Agreement with Alabama Medicaid Agency and agree to abide by the State pharmacy provider tax law.(c) Pharmacies bordering Alabama are defined as those pharmacies located not more than 30 miles from the border of Alabama.(3) Pharmacies Not Bordering Alabama(a) Drugs dispensed must be in concurrence with the limitations in place for in-state providers.(b) Reimbursement will be made only for hemophilia products and specialty drugs which are not readily available in-state, and drugs dispensed to Medicaid recipients who may be traveling outside the state of Alabama.(c) Providers of specialty drugs shall list the names of the drugs for which they intend to request reimbursement as well as the GCN or NDC numbers for each drug in the letter requesting enrollment with the Alabama Medicaid Agency.(d) Pharmacies not bordering Alabama will be enrolled by the Medicaid fiscal agent on a temporary basis.(e) Pharmacies not bordering Alabama are defined as those pharmacies located more than 30 miles from the border of Alabama. Author: Lynn Sharp, Associate Director, Policy Development Unit
Ala. Admin. Code r. 560-X-16-.07
Rule effective October 1, 1982. Amended: Effective June 8, 1984; April 14, 1992. Amended: Filed January 6, 1998; effective February 10, 1998. Amended: Filed June 8, 1999; effective July 13, 1999. Amended: Filed December 8, 1999; effective January 12, 2000. Amended: Filed February 5, 2001; effective March 12, 2001.Statutory Authority: State Plan, Attachments 3.1A, 4.18B; Title XIX, Social Security Act; 42 C.F.R. §§401, et seq., 447.331; Omnibus Budget Reconciliation Act of 1990 ( Public Law 101-508.