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e-CFR data is current as of February 24, 2021


42 CFR--PART 438

View Printed Federal Register page 85 FR 87101 in PDF format.

Amendment(s) published December 31, 2020, in 85 FR 87101

Effective Dates: Mar. 1, 2021

4. Section 438.3 is amended by revising paragraphs (s) introductory text and (s)(4) and (5) to read as follows:

§438.3   Standard contract requirements.

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(s) Requirements for MCOs, PCCMs, PIHPs, or PAHPs that provide covered outpatient drugs. Contracts that obligate MCOs, PCCMs, PIHPs, or PAHPs to provide coverage of covered outpatient drugs must include the following requirements:

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(4) The MCO, PCCM, PIHP, or PAHP must operate a drug utilization review program that complies with the requirements described in section 1927(g) of the Act and part 456, subpart K, of this chapter, as if such requirement applied to the MCO, PCCM, PIHP, or PAHP instead of the State.

(5) The MCO, PCCM, PIHP, or PAHP must provide a detailed description of its drug utilization review program activities to the State on an annual basis.

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