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Example: A pharmacist is dispensing 20 tablets of loperamide for an acute diarrhea episode.The tablets come in a package of 40 tablets and the shelf price for the package is .Refer to the MHCP does not allow automatic refills.Prescription refills are not eligible for payment without an explicit request from a recipient or authorized caregiver for each refill based on continued medical necessity.Pharmacies should not dispense drugs directly to a patient if the drugs are intended for use during a clinic or other outpatient visit.The following policies apply to pharmacists prescribing OTC medications: Example: If a pharmacist is dispensing two bisacodyl tablets for a one-time bowel preparation and the shelf price of the 12-count box of bisacodyl tablets is , submit as the usual and customary price for the two tablets.Submit (the pro-rated shelf price) as usual and customary.

The first segment (5-digits) identifies the manufacturer or labeler of the drug, the second segment (4-digits) identifies the drug, and the third segment (2-digits) the package size.

This law does not affect E-prescribed, faxed or prescriptions phoned in to the pharmacy by the prescriber.

Hand-written prescriptions must be executed on a tamper-resistant prescription blank with at least one characteristic from all three categories as outlined in the To be eligible for coverage, prescriptions must be written by an enrolled prescriber.

Direct questions about the SMAC program or specific SMAC prices to Change Healthcare.

To initiate a SMAC price review, complete the and fax it to the Change Healthcare Minnesota SMAC Helpdesk at: 877-350-2810.

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