DHS 109.31(3)(e) (e) SeniorCare providers may dispense certain maintenance drugs specified under s. DHS 107.10 (3) (e), in amounts up to but not to exceed a 100-day supply, as prescribed by a physician.

DHS 109.31 Note Note: The maintenance drugs listed in section DHS 107.10 (3) (e) are: digoxin, digitoxin, digitalis; hydrochlorothiazide and chlorothiazide; prenatal vitamins; fluoride; levothyroxine, liothyronine and thyroid extract; phenobarbital; phenytoin; and oral contraceptives.

DHS 109.31 Note Note: Par. (e) is amended by 2023 Wis. Act 71 as shown below, effective upon approval by the federal secretary of health and human services of a waiver or amendment to a waiver requested under Section (3) of 2023 Wis. Act 71. If the waiver or amendment to a waiver requested under Section 3 is denied, the amendment by 2023 Wis. Act 71, as shown below, is void.

DHS 109.31 Note (e) SeniorCare providers may dispense certain maintenance drugs specified under s. DHS 107.10 (3) (e) or any other drug, as determined by the department on the basis of clinical considerations, safety, costs, and other factors, in amounts up to but not to exceed a 100-day supply, as prescribed by a physician.

DHS 109.31(3)(f) (f) The only general category of over-the-counter drugs that shall be covered are the insulins.

DHS 109.31(3)(g) (g) The innovator of a multiple-source drug shall be a covered service only when the prescribing provider under sub. (1) certifies by writing the phrase “brand medically necessary” on the prescription.

DHS 109.31(3)(h) (h) SeniorCare shall only cover vaccines that are recommended for immunization to adults by the federal centers for disease control and prevention’s advisory committee on immunization practices and administered by a SeniorCare provider in an allowed place of service.

DHS 109.31(4) (4) Lock-in program.

DHS 109.31(4)(a) (a) Required when program is abused. If the department discovers that a participant is abusing the program, including the type of abuse under s. DHS 109.61 (1) and (5), the department may require the participant to designate one pharmacy as the SeniorCare lock-in provider of the participant’s choice.

DHS 109.31(4)(b) (b) Selection of lock-in provider. The department shall allow a participant to choose a lock-in provider from the department’s current list of certified SeniorCare providers. The participant’s choice shall become effective only with the concurrence of the designated lock-in provider.

DHS 109.31(4)(c) (c) Failure to cooperate. If the participant fails to designate a lock-in provider within 15 days after receiving a formal request from the department, the department shall designate a lock-in provider for the participant.

DHS 109.31(5) (5) Non–covered services. In addition to possible non-coverage without prior authorization of some drugs under sub. (2) (b) 2., the following drugs are not covered under this chapter:

DHS 109.31(5)(a) (a) A drug not covered under the medical assistance program under s. DHS 107.10 (4).

DHS 109.31(5)(b) (b) A drug produced by a manufacturer who has not entered into a rebate agreement with the department, as required by s. 49.688, Stats.

DHS 109.31(6) (6) Drug review, counseling and recordkeeping.

DHS 109.31(6)(a) (a) In addition to complying with ch. Phar 7, a SeniorCare provider shall do all of the following:

DHS 109.31(6)(a)1. 1. Provide for a review of drug therapy before each prescription is filled or delivered to a SeniorCare participant. The review shall include screening for potential drug therapy problems including therapeutic duplication, drug-disease contraindications, drug-drug interactions, incorrect drug dosage or duration of drug treatment, drug-allergy interactions and clinical abuse or misuse.

DHS 109.31(6)(a)2. 2. Offer to discuss with each SeniorCare participant, the participant’s legal representative or the participant’s caregiver who presents the prescription, matters which, in the exercise of the SeniorCare provider’s professional judgment and consistent with state statutes and rules governing provisions of this information, the SeniorCare provider deems significant, including the following:

DHS 109.31(6)(a)2.a. a. The name and description of the medication.

DHS 109.31(6)(a)2.b. b. The route, dosage form, dosage, route of administration, and duration of drug therapy.

DHS 109.31(6)(a)2.c. c. Specific directions and precautions for preparation, administration and use by the patient.

DHS 109.31(6)(a)2.d. d. Common severe side effects or adverse effects or interactions and therapeutic contraindications that may be encountered, including how to avoid them, and the action required if they occur.

DHS 109.31(6)(a)2.e. e. Techniques for self-monitoring drug therapy.

DHS 109.31(6)(a)2.f. f. Proper storage.

DHS 109.31(6)(a)2.g. g. Prescription refill information.

DHS 109.31(6)(a)2.h. h. Action to be taken in the event of a missed dose.

DHS 109.31(6)(a)3. 3. Make a reasonable effort to obtain, record and maintain at least the following information regarding each SeniorCare participant for whom the SeniorCare provider dispenses drugs under the SeniorCare program:

DHS 109.31(6)(a)3.a. a. The participant’s name, address, telephone number, date of birth or age and gender.

DHS 109.31(6)(a)3.b. b. The participant’s medical history where significant, including any disease state or states, known allergies and drug reactions, and a comprehensive list of medications and relevant devices.