in-20250917-IR-405250436FNA: The Office of Medicaid Policy and Planning (OMPP) is soliciting public comment on amending rules at 405 IAC 5-24-6 concerning the professional dispensing fee. OMPP seeks comment on the affected citation listed and any other provisions of Title 405 that may be affected by this rulemaking.

TITLE 405 OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES Notice of First Public Comment Period LSA Document #25-436 PROFESSIONAL DISPENSING FEE PURPOSE OF NOTICE ADDITIONAL DOCUMENTS Regulatory Analysis: 20250917-IR-405250436RAA Notice of Public Hearing: 20250917-IR-405250436PHA CITATIONS AFFECTED: 405 IAC 5-24-6 AUTHORITY: IC 12-15-31.1 OVERVIEW Basic Purpose and Background OMPP is required by IC 12-15-31.1 to conduct a survey of pharmacy providers every two (2) years to assess the appropriate level of dispensing fees to be paid to providers for prescribed drugs, including an evaluation of dispensing fees in other states and the policies of the federal Centers for Medicare and Medicaid Services. The proposed rule amends those fees in response to that assessment. For purposes of IC 4-22-2-28.1, small businesses affected by this rulemaking may contact the Small Business Regulatory Coordinator: For purposes of IC 4-22-2-28.1, the Small Business Ombudsman designated by IC 5-28-17-6 is: Resources available to regulated entities through the small business ombudsman include the ombudsman's duties stated in IC 5-28-17-6, specifically IC 5-28-17-6(9), investigating and attempting to resolve any matter regarding compliance by a small business with a law, rule, or policy administered by a state agency, either as a party to a proceeding or as a mediator. REQUEST FOR PUBLIC COMMENT OMPP is soliciting public comment on the proposed rule. Comments may be submitted in one of the following ways: COMMENT PERIOD DEADLINE All comments must be postmarked or time stamped not later than October 27, 2025. The rule, Regulatory Analysis, appendices referenced in the Regulatory Analysis, and materials incorporated by reference (if applicable) are on file at the Family and Social Services Administration, 402 West Washington Street, Room W451, Indianapolis, Indiana and are available for public inspection. Copies of the rule, Regulatory Analysis, and appendices referenced in the Regulatory Analysis are available at the Family and Social Services Administration office. If OMPP does not receive substantive comments during the public comment period or public hearing, the rule may be adopted with text that is the same as or does not substantially differ from the text of the proposed rule published in this notice. PROPOSED RULE Sec. 6. (a) For purposes of this rule, the Medicaid professional dispensing fee maximum is ten dollars and forty-eight cents ($10.48) nine dollars and sixty-three cents ($9.63). (b) A maximum of one (1) Medicaid professional dispensing fee per month is allowable per member, per drug order for legend or nonlegend drugs provided to members residing in Medicaid certified long term care facilities. (c) The practice of split billing of legend or nonlegend drugs, defined as the dispensing of less than the prescribed amount of drug solely for the purpose of collecting more Medicaid professional dispensing fees than would otherwise be allowed, or to circumvent prior authorization criteria, is prohibited. In cases in which Whenever the pharmacist's professional judgment dictates that a quantity less than the amount prescribed be dispensed, the pharmacist should contact the prescribing practitioner for authorization to dispense a lesser quantity. The pharmacist must shall document the result of the contact and the pharmacist's rationale for dispensing less than the amount prescribed on the prescription or in the pharmacist's records.