Prescribed Drugs Provider Manual - Iowa Department of Human ...

IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage92DateAugust 1, 2013Claim the additional reimbursement by placing a “3” in “Unit Dose Indicator”(field 429-DT) for electronic claims, as explained under Point of Sale ClaimSubmission, or a “09” in the Basis Cost (field 14) on the paper claim form, asexplained under Paper Claim Submission. The additional reimbursement willbe automatically added, possibly resulting in reimbursement that is higherthan your submitted charge.Credits: Payment may be made only for unit-dose-packaged drugs that areconsumed by the patient. Any previous charges for intact unit-dosepackages returned to the pharmacy must be credited to the Medicaidprogram. Such credits may be shown on future billings. If no additionalbillings are to be made, direct a refund in the drug cost component.In accordance with state and federal law, proper crediting to Iowa Medicaid isrequired for the return of unused medications upon therapy discontinuationor a member’s discharge, transfer, or death.Both the long-term-care pharmacy and the nursing facility are subject tofinancial review by the state to ensure that medications are being returned tothe pharmacy when permitted by state and federal law and proper credits areapplied to the Iowa Medicaid program.4. Reimbursement for VaccinationsVaccines for mass immunizations, such as might occur with nursing homepatients, are payable to a pharmacy. Examples are vaccines such asinfluenza vaccine and pneumonia vaccine.Payment is allowed on a per-dose basis. Reimbursement is limited to thelesser of the pharmacist’s usual charge per dose or the cost of the dose plusthe current professional fee. Each dose must be billed on the billing form ofthe patient receiving the dose. Where available, unit-dose syringes should bedispensed.In 1995, the Department implemented the Vaccines for Children (VFC)immunization program. The VFC Program was created to meet thevaccination needs of children from birth through 18 years of age. Theprogram is intended to help raise childhood immunization levels, especiallyamong infants and young children.