Prescription Drugs Provided by Health Centers

Federally Qualified Health Centers are required to ensure access to pharmacy services, either on site or through arrangements with other providers. In order for an eligible provider to be paid for filling a prescription drug, the pharmacist must complete all of the following:

1. have an existing provider agreement with OHCA,
2. submit the claim in a format acceptable to OHCA,
3. have a prior authorization before filling the prescription, if a prior authorization is necessary,
4. have a proper brand name certification for the drug, if necessary, and
5. bill the lower of the usual and customary charges to the general public or the estimated acquisition cost.

Manufacturer Rebates

In order to ensure that Oklahoma SoonerCare is receiving the best possible pricing for pharmacy purchases, OHCA collects rebates from drug manufacturers on a quarterly basis to offset prescription expenditures, in accordance with the Federal Drug Rebate Program.

In order to document expenditures for rebates, OHCA must report its SoonerCare drug utilization to the manufacturer.

Health Centers participating in the 340B prescription drug program

Under Section 340B of the Public Health Service Act (42 U.S.C. § 256b), Health Centers are eligible to purchase covered drugs at discounted prices. In addition to other requirements, eligible Health Centers can only bill SoonerCare for their acquisition cost plus a reasonable dispensing fee for drugs purchased through the 340B program. (See OAC 317:30-5-664.6.)

If a Health Center participates in the 340B program, the Health Center must enroll and obtain a separate provider number, in order to identify those drugs that are purchased through the 340B program.