14105.455. (Amended by Stats. 2011, Ch. 29, Sec. 16.)
(a)Pharmacy providers shall submit their usual and…#
(a) Pharmacy providers shall submit their usual and customary charge when billing the Medi-Cal program for prescribed drugs.
(b)“Usual and customary charge” means the lower of the…#
(b) “Usual and customary charge” means the lower of the following:
(1) The lowest price reimbursed to the pharmacy by other third-party payers in California, excluding Medi-Cal managed care plans and Medicare Part D prescription drug plans.
(2) The lowest price routinely offered to any segment of the general public.
(c)Donations or discounts provided to a charitable…#
(c) Donations or discounts provided to a charitable organization are not considered usual and customary charges.