§ 1121.55. Method of payment.

 (a)  The Department will pay a pharmacy for a compensable legend and nonlegend drug (after deducting the applicable copayment amount, as described in §  1101.63(b) (relating to payment in full)), the lowest of the following amounts:

   (1)  The estimated acquisition cost (EAC) for the drug, multiplied by the number of units dispensed, plus a $4 dispensing fee.

   (2)  The State MAC for the drug, multiplied by the number of units dispensed, plus a $4 dispensing fee.

   (3)  The provider’s usual and customary charge to the general public.

 (b)  The Department will pay a pharmacy for a compensable compounded prescription at the lower of the cost of all ingredients plus a $5 dispensing fee or the provider’s usual and customary charge to the general public.

 (c)  The provider shall bill the Department at its usual and customary charge to the general public.

   The provisions of this §  1121.55 amended under sections 201, 403 and 443.4 of the Public Welfare Code (62 P. S. § §  201, 403 and 443.4).

   The provisions of this §  1121.55 amended August 10, 1984, effective September 1, 1984, 14 Pa.B. 2926; amended January 16, 1987, effective March 1, 1987, 17 Pa.B. 261; amended December 14, 1990, effective January 11, 1991, 20 Pa.B. 6167; amended January 24, 1992, effective April 1, 1991, for the Manufacturers’ Rebate Program and September 1, 1991 for the pharmacy dispensing fee increase, 22 Pa.B. 361; amended September 22, 1995, effective October 1, 1995, 25 Pa.B. 3978. Immediately preceding text appears at serial pages (177064) to (177065).

   (Editor’s Note: This regulation was promulgated under section 6(b) of the Regulatory Review Act (71 P. S. §  745.6(b)).)

   This section cited in 6 Pa. Code §  22.11 (relating to general payment principles); and 55 Pa. Code §  1121.51 (relating to general payment policy).