Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 10 - PHARMACEUTICAL SERVICES › Section 10-3 - Definitions

Current through July 13, 2024
Except as otherwise specified in Chapter 1 of the Wyoming
				  Medicaid Rules or as defined in this section, the terminology used in this
				  chapter is the standard terminology and has the standard meaning used in
				  healthcare, Medicaid, and Medicare.
(a) "AB Rated." An "AB rated" generic drug
				product is one that the FDA has determined to be bioequivalent to a branded
				drug. A generic drug is considered bioequivalent to a branded drug if it
				contains the same active pharmaceutical ingredient as the branded drug and
				there is no significant difference in the formulation, quality, and
				effectiveness of the two (2) drugs.
(b) "Average wholesale price (AWP)." A
				national average of list prices charged by wholesalers to pharmacies.
(c) "Board of Pharmacy." The Wyoming State
				Board of Pharmacy, its agent, designee or successor.
(d) "Brand name." The proprietary or trade
				name selected by the manufacturer, given to a drug, and placed upon a drug, its
				container, label, or wrapping at the time of packaging.
(e) "Compound Drug." A drug prepared by a
				pharmacist who mixes or adjusts drug ingredients to customize a medication to
				meet a patient's individual needs.
(f) "Device." Any article or healthcare
				product intended for use in the diagnosis of disease or other condition or for
				use in the care, treatment, or prevention of disease that does not achieve any
				of its primary intended purposes by chemical action or by being
				metabolized.
(g) "Drug Efficacy
				Study Implementation (DESI) drugs." Drugs determined by the United States Food
				and Drug Administration (FDA) to be less than effective. This definition
				applies to all drugs that are similar, related, or identical to these drugs
				pursuant to FDA designation. Compound formulations which contain a DESI drug
				are considered to be DESI compounds/DESI drugs.
(h) "Drug Utilization Review (DUR)
				requirements." The Drug Utilization Review Requirements as set forth in Chapter
				9 of the Board of Pharmacy Rules and 42 C.F.R. Part 456. A DUR program shall
				include prospective drug review, retrospective drug use review, and an
				educational program.
(i) "Federal
				Upper Limit (FUL)." The maximum amount the federal government (Centers for
				Medicare and Medicaid Services) will pay for multiple source drugs.
(j) "Food and Drug Administration (FDA)." The
				Food and Drug Administration of the United States of America, its agent,
				designee, or successor.
(k) "Local
				Trade Area." The geographic area surrounding the client's residence, including
				portions of states other than Wyoming, commonly used by other persons in the
				same area to obtain pharmaceutical services.
(l) "Gross Amount Due (GAD)." The sum of the
				submitted product component cost and the dispensing fee submitted by the
				pharmacy on a prescription claim.
(m) "Ingredient Cost Submitted." The product
				cost submitted by the pharmacy on a prescription claim.
(n) "Maintenance drug." A covered
				prescription drug prescribed for a chronic condition (i.e., diabetes,
				arthritis, high blood pressure, or heart conditions).
(o) "Multiple source drug." A drug marketed
				or sold by two (2) or more manufacturers or labelers or a drug marketed or sold
				by the same manufacturer or labeler under two (2) or more different proprietary
				names.
(p) "National Average Drug
				Acquisition Cost (NADAC)." A drug price point that is calculated based on
				average pharmacy acquisition cost of a particular drug.
(q) "National drug code (NDC)." The code
				number determined for and assigned to a drug by the FDA.
(r) "One month supply." The quantity of drugs
				sufficient to last up to thirty-four (34) days.
(s) "Pharmaceutical service." Drugs, devices
				or medical supplies that are covered services, as defined in this
				Chapter.
(t) "Pharmacist." A person
				licensed to practice pharmacy by the Wyoming State Board of Pharmacy or a
				similar board or agency in another state.
(u) "Pharmacy Therapeutics (P&T)
				Committee." An advisory committee that shall review evidence based research and
				provide recommendations to the Department as to the clinical effectiveness of a
				service or medication within a therapeutic drug class.
(v) "Preferred Drug List (PDL)." A list of
				preferred pharmaceutical substances for selected pharmacologic or therapeutic
				classes that is maintained by the Department, is designed to maximize clinical
				and economic outcomes, and is incorporated herein by reference.
(w) "Prescription drug." A drug that is:
(i) Prescribed by a practitioner acting
				within the scope of his practice; and
(ii) Dispensed by a provider pursuant to a
				written prescription that is recorded and maintained in the provider's
				records.