Kentucky Administrative Regulations › Title 803 - LABOR CABINET › Chapter 25 - Department of Workers' Claims › Section 803 KAR 25:270 - Pharmaceutical Formulary

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				342.0011(13),
				342.020,
				342.035.
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				342.260(1) requires the
				commissioner to promulgate administrative regulations necessary to carry on the
				work of the department and the work of administrative law judges so long as
				those administrative regulations are consistent with KRS Chapter 342 and KRS
				Chapter 13A.
				KRS
				342.035 requires the commissioner to develop
				or adopt a pharmaceutical formulary and promulgate administrative regulations
				to implement the developed or adopted pharmaceutical formulary. This
				administrative regulation establishes the formulary and provides guidance to
				implement the adopted formulary.
Section
			 1. Definitions.
(1) "Carrier" or
			 "Insurance Carrier" means any insurer authorized to insure the liability of
			 employers arising under Chapter 342 of the Kentucky Revised Statutes, an
			 employer authorized by the commissioner to pay directly the compensation
			 provided in Chapter 342 of the Kentucky Revised Statutes as those liabilities
			 are incurred, a self-insured group, and any person acting on behalf of or as an
			 agent of the insurer, self-insured employer, or self-insured group.
(2) "Commissioner" means the commissioner
			 charged in
			 KRS
			 342.228 to administer the Department of
			 Workers' Claims and whose duties are stated in
			 KRS
			 342.230.
(3) "Compound" or "Compounding" means the
			 process of combining, mixing, or altering ingredients to create a medication
			 that is tailored to meet the needs of an individual patient.
(4) "Department" or "Department of Workers'
			 Claims" means the governmental agency whose responsibilities are provided in
			 KRS
			 342.228.
(5) "Dispense" means to deliver a drug to an
			 ultimate user pursuant to the lawful order of a medical provider, including the
			 packaging, labeling, or compounding necessary to prepare the drug for
			 delivery.
(6) "Drug" means a
			 substance recognized as a drug in the official United States Pharmacopoeia,
			 official Homeopathic Pharmacopoeia of the United States, or any supplement to
			 them, which is intended for use in the diagnosis, care, mitigation, treatment,
			 or prevention of disease in man.
(7) "Employee" means those natural persons
			 constituting an employee subject to the provisions of the Act as defined in
			 KRS 342.640
			 and the employee's legal counsel.
(8) "Employer" means those persons
			 constituting an employer as defined in
			 KRS
			 342.630, the employer's insurance carrier,
			 self-insured group or other payment obligor, third party administrator, other
			 person acting on behalf of the employer in a workers' compensation matter, and
			 the employer's legal counsel.
(9)
			 "Formulary" or "Pharmaceutical Formulary" means the pharmaceutical formulary
			 developed or adopted by the commissioner pursuant to
			 KRS
			 342.035(8)(b).
(10) "Medical Provider" means a natural
			 person who has prescriptive authority for drugs under the professional
			 licensing laws of Kentucky, another state, or federal law, unless that person's
			 license has been revoked, suspended, restricted, or probated.
(11) "N" or "N status" means the drug is a
			 non-preferred drug.
(12) "Natural
			 person" means a biological human being.
(13) "Non-prescription drug" or
			 "over-the-counter-drug" means a drug that may be sold without a
			 prescription.
(14) "Person" means
			 an individual, corporation, government, governmental subdivision, agency,
			 business, estate, trust, partnership, association, or any other legal
			 entity.
(15) "Pharmacist" means a
			 natural person lawfully licensed to engage in the practice of the profession of
			 pharmacy.
(16) "Preauthorization"
			 means the process whereby payment for a medical service or course of treatment
			 is assured in advance by a carrier.
(17) "Prescription" or "prescribed" means a
			 written, electronic, or oral order for a drug, signed, given, or authorized by
			 a medical provider and intended for use in the diagnosis, care, mitigation,
			 treatment, or prevention of disease in man.
(18) "Prescription Drug" means:
(a) A substance for which federal or state
			 law requires a prescription before the substance may be legally dispensed to
			 the public;
(b) A drug that under
			 federal law is required, before being dispensed or delivered, to be labeled
			 with the statement: "Caution: federal law prohibits dispensing without
			 prescription"; "Rx only"; or another legend that complies with federal law;
			 or
(c) A drug that is required by
			 federal or state statute or regulation to be dispensed on prescription or that
			 is restricted to use by a medical provider only.
(19) "Refill" means a prescription for the
			 same drug, at the same dose or strength, in the same quantity and frequency,
			 and with the same instructions as was initially prescribed.
(20) "Utilization Review" is defined by
			 803
			 KAR 25:190.
(21) "Y" or "Y status" means the drug is a
			 preferred drug.