Statutes, codes, and regulations
South Dakota Administrative Rules
Title 67 - Department of Social ServicesArticle 67:16 - Covered medical services
Chapter 67:16:14 - Prescription drugs
Section 67:16:14:22 - Cost of drug not covered if substitution not made or prior authorization obtained

S.D. Admin. R. 67:16:14:22

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Current through Register Vol. 51, page 57, November 12, 2024
Section 67:16:14:22 - Cost of drug not covered if substitution not made or prior authorization obtained

If the department informs a pharmacist that a requested drug requires prior authorization and the recipient indicates to the pharmacist that the recipient wishes to proceed, the pharmacist must contact the medical professional who wrote the prescription and request permission to substitute a therapeutically-equivalent drug.

If the request to substitute is not successful, the pharmacist must inform the medical professional that the medical assistance program will not cover the cost unless the medical professional can justify the use of the drug and ultimately receives approval from the department to dispense the drug as written.

S.D. Admin. R. 67:16:14:22

32 SDR 129, effective 2/1/2006.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.