Section 22.63. Other provisions for providing services by mail

(a) Mail orders for prescription drugs. Providers shall provide PACE claimants who wish to request PACE Program benefits by mail with order forms and clear instructions for submitting mail orders. As a minimum, order forms submitted shall include the claimant’s signature, address, telephone number, where applicable and PACE identification card number. For each initial mail-ordered prescription to be filled, a valid prescription as written by the licensed prescriber shall accompany the order form. When mail-ordered prescription drugs can not be delivered by mail as restricted by the standards of the State Board of Pharmacy, 49 Pa. Code § 27.18 (relating to standards of practice) and other applicable State and Federal statutes, or can not be dispensed for another reason, the provider shall, within 2 working days of the provider’s receipt of the mail order, notify the claimant and the prescriber by telephone or mail and return the written prescription to the claimant, except as provided for under § 22.62(g)(3) (relating to conditions of provider participation).

(b) Telephone prescription orders. Refill prescription orders may be accepted by telephone. Providers of prescription services by mail may not accept initial prescription orders for PACE Program benefits by telephone except when all of the following control steps have been taken:

(1) The provider has secured the name, address and telephone number of the licensed prescriber making the telephone order.

(2) The provider has secured the license number assigned by the appropriate State licensing board to the licensed prescriber making the telephone order.

(3) The provider has secured the United States Drug Enforcement Administration registration number of the licensed prescriber making the telephone order unless that prescriber has no registration number.

(4) The provider has verified that the information secured is correct and that the telephone order originated from the licensed prescriber.

(c) Dispensing prescription drugs by mail.

(1) Prescription drugs dispensed by mail may not be mailed to an address outside this Commonwealth. Packages used for the dispensing of prescription drugs by mail shall bear the words ‘‘DO NOT FORWARD’’ on the face which bears the claimant’s address.

(2) A prescription drug delivered by mail shall be accompanied, as a minimum by the following:

(i) A Universal Claim Form.

(ii) Clear instructions to the claimant about the completion, signing and return of the Universal Claim Form accompanied by payments due from the claimant if full payment has not been received in advance of delivery. These instructions shall advise the claimant that the Universal Claim Form and payments due shall be returned to the provider within 5 days of the claimant’s receipt of the prescription drug.

(iii) Information regarding the use and storage of the prescription drug, as appropriate.

(iv) A postage paid, provider self-addressed envelope to facilitate the claimant’s response to receipt of the prescription drug.

(d) Other provisions for control of PACE benefit utilization.

(1) When a provider authorized to provide prescription services by mail to PACE claimants observes irregularities in prescriptions, dosages, medication history, prescriber utilization, mailing address, claimant name or PACE identification card number or other similar kinds of irregularities, the provider shall make an immediate comparison of signatures in the claimant’s file.

(2) The provider shall discontinue prescription services by mail to a claimant who fails to return the Universal Claim Form appropriately completed, fails to submit all due claimant payments, or is suspected of submitting false or fraudulent prescription order or false or fraudulent information on a Universal Claim Form.

(3) Whenever a provider of prescription services by mail discontinues services under paragraph (2), the provider shall notify the Department of the claimant’s name and PACE identification card number and the name of the prescriber of prescriptions related to the reasons for the provider’s decision to discontinue services.

(e) Mail order service provider accessibility to claimants.

(1) Enrolled providers authorized to provide prescription services by mail shall, as required in the provider agreement, arrange for access by claimants and appropriate medical personnel treating a claimant to a registered pharmacist in the event of drug concerns and emergency situations including, but not limited to, the following:

(i) Disturbing drug side effects and reactions.

(ii) Drug interactions.

(iii) Dosage.

(iv) Drug ingestion or administration and proper storage.

(v) Drug identification—for example—in the event of lost labels.

(vi) Emergency medical treatment of a claimant.

(2) Access shall include the acceptance of collect calls from claimants and appropriate medical personnel or a toll-free telephone number, accessible by claimants and appropriate medical personnel on a 9 a.m. to 5 p.m. basis during the days when the pharmacy is normally open for business. The provider shall issue clear instructions to the claimant regarding the access number and its appropriate use.

The provisions of this § 22.63 adopted December 13, 1985, effective December 14, 1985, 15 Pa.B. 4427; corrected December 27, 1985, effective December 14, 1985, 15 Pa.B. 4581.

Notation

Cross References

This section cited in 6 Pa. Code § 22.62 (relating to conditions of provider participation).