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Code of Federal Regulations Title 20. Employees' Benefits § 20.10.809 How are payments for medicinal drugs determined?

Current as of October 02, 2022 | Updated by FindLaw Staff

Payment for medicinal drugs prescribed by physicians shall not exceed the amount derived by multiplying the average wholesale price, or as otherwise specified by OWCP, of the medication by the quantity or amount provided, plus a dispensing fee. OWCP may, in its discretion, contract for or require the use of specific providers for certain medications.

(a) All prescription medications identified by National Drug Code (NDC) will be assigned an average wholesale price representing the product's nationally recognized wholesale price as determined by surveys of manufacturers and wholesalers, or by other method designated by OWCP. The Director will establish the dispensing fee, which will not be affected by the location or type of provider dispensing the medication.

(b) The NDCs, the average wholesale prices, and the dispensing fee shall be reviewed from time to time and updated as necessary.

(c) With respect to prescribed medications, OWCP may require the use of generic equivalents where they are available.

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Cite this article: FindLaw.com - Code of Federal Regulations Title 20. Employees' Benefits § 20.10.809 How are payments for medicinal drugs determined? - last updated October 02, 2022 | https://codes.findlaw.com/cfr/title-20-employees-benefits/cfr-sect-20-10-809/

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