4.3 Rates of Payment

Medications will be purchased at usual and customary rates. Prescription medications will be generic unless the brand name is specified by the prescriber with a designation of "Dispense as Written." The maximum amount of prescribed medication that may be purchased by DVR at one time is a 30-day supply or the actual prescribed amount, whichever is less. Counselors will make maximum effort to locate comparable benefits. Purchase of prescribed medication for more than three months requires supervisor approval and reassessment after each 3-month period.

Oral medication administered in a physician's office is considered part of the physician's services and does not warrant separate payment.

Injectable medications administered in a physician's office are payable to the physician. Such injections are usually provided in conjunction with an Evaluation and Management service. Except for chemotherapy agents, payment for an injection includes the cost of medication, associated supplies, and administration. Any medication provided by the physician for the patient to self-administer or be given at home shall be purchased from a pharmacy.

Methadone, LAAM, or other approved controlled substances may be purchased from a licensed drug and alcohol treatment program only when prescribed as part of the program’s treatment protocol for the eligible individual. Approved programs must be licensed under the Colorado Department of Human Services, Office of Behavioral Health. Approved controlled substances provided by the licensed drug and alcohol treatment program will be paid at the usual and customary fee charged by the program to other participants. Fees for the dispensing and administration of such medications does not warrant additional payment. DVR cannot purchase or reimburse the cost of prescribed marijuana.