Special Processing for Prescription Drug Co-payment 400-29-60-05-01

(Revised 10/02 ML #2827)

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Basic Care recipients may have prescriptions for name-brand drugs and be required to pay the co-payment. For clients with a recipient liability such payments will reduce the client’s recipient liability in Medicaid. Drug co-payments are to be deducted in the month the expense is incurred. This may require reworking the client’s budget in both TECS and in the Resident Payment System for Basic Care in order to show additional co-payments during the month.

 

Since many Basic Care recipients will have a number of prescriptions that are often of a regular and recurring nature, for these clients the county can reasonably anticipate the ongoing co-payments. In order to reduce the amount of rework, the county should prospectively budget these deductions when the budget is initially created.

 

When there are occasional co-payments in addition to the regular pattern, the county will need to rework the month the co-payment was incurred in order to deduct those payments from income. If there is a reduction in the co-payment, do not rework the case for a reduction in a prior month.

 

When the county learns of a change in the regular pattern of name-brand prescriptions, the prospective budget for the next month should be adjusted accordingly.

 

In cases that do not have a recipient liability for Medicaid and have co-payments for prescription drugs, it is important to use the deduction in the Resident Payment System. When there is no recipient liability the deduction affects the distribution of any client resource to room and board costs.