Title 42 - Chapter IV - Subchapter C - Part 438 (Managed Care)
Subpart A (General Provisions)
- 42 CFR Section 438.3(s) - Requirements for MCOs, PIHPs, or PAHPs that provide covered outpatient drugs
Title 42 - Chapter IV - Subchapter C - Part 440 (Services: General Provisions)
Subpart A (Definitions)
- 42 CFR Section 440.70 - Home Health Services
- 42 CFR Section 440.120 - Prescribed drugs, dentures, prosthetic devices, and eyeglasses
Title 42 - Chapter IV - Subchapter C - Part 447 (Payments for Services)
Subpart I (Payment for Drugs)
- 42 CFR Section 447.500 – Basis and Purpose
- 42 CFR Section 447.502 – Definitions
- 42 CFR Section 447.504 - Determination of average manufacturer price
- 42 CFR Section 447.505 – Determination of Best Price
- 42 CFR Section 447.506 – Authorized Generic Drugs
- 42 CFR Section 447.508 – Exclusion from Best Price Of Certain Sales At A Nominal Price
- 42 CFR Section 447.510 – Requirements for Manufacturers
- 42 CFR Section 447.512 – Drugs: Aggregate Upper Limits of Payment
- 42 CFR Section 447.516 – Upper Limits For Drugs Furnished As Part of Services
- 42 CFR Section 447.518 – State Plan Requirements, Findings and Assurances
- 42 CFR Section 447.520 – FFP: Conditions Relating To Physician-Administered Drugs
Title 42 – Chapter IV – Subchapter C – Part 456 (Utilization Control)
Subpart K (Drug Use Review Program and Electronic Claims Management System for Outpatient Drug Claims)
- 42 CFR Section 456.700 – Scope
- 42 CFR Section 456.702 – Definitions
- 42 CFR Section 456.703 – Drug Use Review Program
- 42 CFR Section 456.705 – Prospective Drug Review
- 42 CFR Section 456.709 – Retrospective Drug Use Review
- 42 CFR Section 456.711 – Educational Program
- 42 CFR Section 456.712 – Annual Report
- 42 CFR Section 456.714 – DUR/Surveillance And Utilization Review Relationship
- 42 CFR Section 456.716 – DUR Board
- 42 CFR Section 456.719 – Funding For DUR Program
- 42 CFR Section 456.722 – Electronic Claims Management System
- 42 CFR Section 456.725 – Funding Of ECM System