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UNOFFICIAL 1737-77

§17-1737-71 Drugs. (a) Medical assistance payments shall be made for drugs when dispensed to eligible recipients within the following guidelines: (1) When prescribed by a practitioner licensed in the United States; (2) The drug has been approved by the U.S. Food and Drug Administration for the purpose for which it is prescribed; (3) The drug can be expected to be of therapeutic value for the disease or condition under treatment; and (4) The drug complies with the Medicaid drug formulary or prior authorization has been obtained from the department's medical

consultant or designee or there is compliance with the prior authorization requirements set forth in section 17-1739.1-4.1. (b) A drug formulary may be maintained as follows: (1) An advisory formulary committee shall be appointed by the director of the department, and shall consist of: (A) A committee consisting of physicians, pharmacists, and other individuals deemed appropriate by the director; or (B) At the option of the State, the State's drug use review (DUR) board; (2) The formulary committee's secretary or drug use review coordinator shall be representatives of the department and selected by the director; (3) The duties of the advisory drug formulary committee shall be to: (A) Meet when called by the chairperson; (B) Develop and maintain a current and effective drug formulary; (C) Advise the department of suggested changes; and (D) Recommend the criteria under which prior authorization may be appropriate; (4) Actions of the advisory drug formulary committee shall be: (A) Subject to the approval of the department; (B) Circulated to appropriate providers; and (C) Effective upon receipt by providers

unless otherwise stated; and

The term of each formulary committee member shall be not more than two years