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OHCA Policies and Rules

317:30-5-77.1. Dispensing quantity

[Revised 09-14-2020]

(a) Prescription quantities shall be limited to a thirty-four (34) day supply, except in the following situations:

(1) The Drug Utilization Review (DUR) Board has recommended a different day supply or quantity limit based on published medical data, including the manufacturer's package insert;

(2) The product is included on the Maintenance List of medications, which are exempted from this limit, and may be dispensed up to a ninety (90) day supply;

(3) The manufacturer of the drug recommends a dispensing quantity less than a thirty-four (34) day supply.

(b) Refills are to be provided only if authorized by the prescriber, allowed by law, and should be in accordance with the current medical and pharmacological practices. A provider may not generate automated refills unless the member has specifically requested such service. Documentation of this request must be available for review by OHCA auditors.

(c) The DUR Board shall develop a Maintenance List of medications which are used in general practice on a continuing basis. These drugs shall be made available through the Vendor Drug Program in quantities up to a ninety (90) day supply when approved by the prescriber. The DUR Board shall review the Maintenance List at least annually. When approved by the prescriber, all maintenance medications must be filled at the maximum quantity allowed after a sufficient stabilization period when dispensed to SoonerCare members who do not reside in a long-term care facility. For members residing in a long-term care facility, chronic medications, including all products on the Maintenance List, must be dispensed in quantities of not less than a twenty-eight (28) day supply.

(d) For products covered by the Oklahoma Vendor Drug Program, the metric quantity shown on the claim form must be in agreement with the descriptive unit of measure applicable to the specific National Drug Code (NDC). Only numeric characters should be entered.  Designations, such as the form of drug, i.e., tabs, caps, suppositories, etc., must not be used. Products should be billed in a manner consistent with quantity measurements.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.