N.H. Admin. Code § He-W 570.13

Current through Register No. 50, December 12, 2024

Section He-W 570.13 - Prescription Co-payment

Recipients shall make co-payments to the pharmacy provider for drug products as follows:

(a) A co-payment in the amount of $1.00 shall be required for each preferred prescription drug and each refill of a preferred prescription drug dispensed;

(b) A co-payment in the amount of $2.00 shall be required for each non-preferred prescription drug and each refill of a non-preferred prescription drug dispensed unless the prescribing provider determines that a preferred prescription drug will be less effective for the recipient, will have adverse effects for the recipient, or both, in which case the co-payment shall be $1.00;

(c) A co-payment in the amount of $1.00 shall be required for a prescription drug that is not identified as either a preferred or non-preferred prescription drug; and

(d) Co-payments for drug products shall not be required:

(1) Of recipients with income at or below 100% of the federal poverty level (FPL);

(2) Of recipients in a nursing facility, hospital, intermediate care facility for individuals with intellectual disabilities, or other medical institution;

(3) Of recipients participating in the home and community based care (HCBC) waiver programs;

(4) Of recipients receiving services that relate to pregnancy in accordance with 42 CFR 447.53(b) (2), or any other medical condition that might complicate the pregnancy;

(5) Of recipients under the age of 18;

(6) For family planning products;

(7) For clozaril or clozapine prescriptions;

(8) Of women eligible through the Breast and Cervical Cancer Treatment Program, pursuant to 42 CFR 435.213;

(9) Of recipients receiving hospice care pursuant to He-W 544; and

(10) Of individuals who are members of a federally recognized Indian tribe or Alaskan natives who have ever been served through the Indian Health Services Program, pursuant to 42 CFR 447.56(a) (x) .

N.H. Admin. Code § He-W 570.13

(See Revision Note at chapter heading He-W 500); ss by #5742, eff 12-1-93, EXPIRED: 12-1-99

New. #7392, eff 10-28-00; ss by #7680, eff 4-20-02; ss by #7712, INTERIM, eff 6-22-02, EXPIRED: 12-19-02

New. #7805, eff 12-21-02; ss by #7976, eff 10-22-03; ss by #9831, eff 12-21-10

Amended byVolume XXXIV Number 50, Filed December 11, 2014, Proposed by #10716, Effective 11/18/2014, Expires11/18/2024.

Amended by Volume XXXVI Number 23, Filed June 9, 2016, Proposed by #11101, Effective 5/25/2016, Expires 5/25/2026.

Amended by Volume XXXVIII Number 23, Filed June 7, 2018, Proposed by #12529, Effective 5/22/2018, Expires 5/22/2028.

Amended by Volume XXXIX Number 2, Filed January 10, 2019, Proposed by #12698, Effective 12/28/2018, Expires 12/28/2028.