(a) Generic drugs. Practitioners shall prescribe generic drugs except in the following circumstances: - (i) When a brand name drug is medically necessary and the appropriate prior authorization criteria has been met,
- (ii) When there is not an AB rated generic available, or
- (iii) When the brand name drug is listed on the Department's preferred drug list as preferred instead of the generic.
(b) Quantities dispensed. - (i) Maintenance drugs.
- (A) Minimum quantities. Except as provided in subparagraph (C), maintenance drugs shall be dispensed in a quantity sufficient for at least a one (1) month supply.
- (B) Maximum quantities. Maintenance drugs shall not be dispensed in an amount which exceeds a ninety (90) day supply.
- (C) Less than a one (1) month supply of a maintenance drug may be dispensed to allow a client to be stabilized on a new or adjusted maintenance drug.
- (ii) Oral contraceptives. The maximum quantity of oral contraceptive which may be dispensed is a ninety (90) day supply.
- (iii) All other drugs. The maximum quantity dispensed for all other conditions shall be a one (1) month supply unless the Department has designated a minimum days supply for a specific drug that exceeds a one month supply.
(c) Days supply. A prescription's day supply must equal the quantity of drug dispensed divided by the daily dose prescribed. A prescription claim will be subject to subsequent recovery if: - (i) The days supply submitted is not supported by the dosing directions as prescribed, or
- (ii) The dosing directions are given as "take as directed" and the pharmacist has not taken appropriate action to obtain and document on the prescription the actual dosing directions given by the practitioner.
- (iii) Extra Doses. The Department does not pre-emptively pay for extra doses in the anticipation of lost or wasted medication.
(d) Tamper resistant prescription pads. Prescriptions written for Medicaid clients shall be written on tamper resistant prescription pads per Section 7002(b) of the U.S. Troop Readiness, Veterans' Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007. The law requires that all written, non-electronic prescriptions for Medicaid outpatient drugs shall be executed on tamper resistant pads in order for them to be reimbursable by the federal government. In addition to all current Wyoming Board of Pharmacy requirements for tamper resistant prescription forms, all prescriptions paid for by Wyoming Medicaid shall meet the following requirements to help ensure against tampering: - (i) Written or computer printed prescriptions shall contain all of the following characteristics:
- (A) One (1) or more industry recognized features designed to prevent unauthorized copying of a completed or blank prescription or prescription form. In order to meet this requirement, all written or computer printed prescriptions shall contain some type of "void" or "illegal" pantograph that appears if the prescription is copied.
- (B) One (1) or more industry recognized features designed to prevent the erasure or modifications of information written on the prescription by the prescriber. This requirement applies only to prescriptions written for controlled substances. In order to meet this requirement, all written or computer printed prescriptions shall contain:
- (I) Quantity check-off boxes plus numeric form of quantity values or alpha and numeric forms of quantity values, and
- (II) Refill indicator (circle or check number of refills or "NR") plus numeric form of refill values or alpha and numeric forms of refill values.
- (C) One (1) or more industry recognized features designed to prevent the use of counterfeit prescription forms. In order to meet this requirement, all written or computer printed prescriptions shall contain security features and descriptions listed on the front and back of the prescription blank.
- (ii) In addition to the guidance outlined above, the tamper resistant requirement does not apply when a prescription is communicated by the prescriber to the pharmacy electronically, verbally, or by fax; when a managed care entity pays for the prescription; or, in most situations, when drugs are provided in designated institutional and clinical settings. The guidance also allows emergency fills with a non-compliant written prescription as long as the prescriber provides a verbal, faxed, electronic, or compliant written prescription within seventy-two (72) hours.
- (iii) Audits of pharmacies may be performed by the Department to ensure that the above requirements are being followed.
048-10 Wyo. Code R. § 10-9