<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 67:16:14:22 Cost of drug not covered if substitution not made or prior authorization obtained.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:14:22"> <META NAME="Description" Content="Administrative Rules 67:16:14:22 Cost of drug not covered if substitution not made or prior authorization obtained."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 10"> <meta name=Originator content="Microsoft Word 10"> <link rel=File-List href="6716140002200d_files/filelist.xml"> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Author>lrpr14296</o:Author> <o:LastAuthor>lrpr14296</o:LastAuthor> <o:Revision>2</o:Revision> <o:TotalTime>10</o:TotalTime> <o:LastPrinted>2006-01-30T19:07:00Z</o:LastPrinted> <o:Created>2006-01-31T15:45:00Z</o:Created> <o:LastSaved>2006-01-31T15:45:00Z</o:LastSaved> <o:Pages>1</o:Pages> <o:Words>126</o:Words> <o:Characters>724</o:Characters> <o:Company>State of South Dakota</o:Company> <o:Lines>6</o:Lines> <o:Paragraphs>1</o:Paragraphs> <o:CharactersWithSpaces>849</o:CharactersWithSpaces> <o:Version>10.4219</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:DoNotRelyOnCSS/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:GrammarState>Clean</w:GrammarState> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:UseMarginsForDrawingGridOrigin/> <w:Compatibility> <w:FootnoteLayoutLikeWW8/> <w:ShapeLayoutLikeWW8/> <w:AlignTablesRowByRow/> <w:ForgetLastTabAlignment/> <w:LayoutRawTableWidth/> <w:LayoutTableRowsApart/> <w:UseWord97LineBreakingRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--> <style> <!-- /* Font Definitions */ @font-face {font-family:Tahoma; 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mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman";} </style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="1026"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> </head> <body lang=EN-US style='tab-interval:.5in'> <div class=Section1> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>67:16:14:22<span class=GramE>&nbsp;&nbsp;Cost</span> of drug not covered if substitution not made or prior authorization obtained.</span></b> 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.<o:p></o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>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.<o:p></o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>Source:</span></b> 32 SDR 129, effective February 1, 2006.<o:p></o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>General Authority:</span></b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A><o:p></o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>Law Implemented:</span></b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A><o:p></o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> </div> </body> </html>