Effective July 1, the Division of Medicaid (DOM) allowed certain physician-administered drugs to be billed and reimbursed as either a medical claim or a pharmacy point-of-sale (POS) claim. Currently, many physician-administered drugs may only be billed as a medical claim. In order to implement this change, DOM has created a new category of drugs and drug-system devices, which may be billed as either medical or pharmacy POS claims. This new category is known as Clinician Administered Drugs and Implantable Drug System Devices (CADD). The list of drugs included in the CADD category is available online. To create the current list, DOM identified the drugs where reimbursing only by medical claims has caused the greatest access issues and targeted those for the CADD category. Additional drugs may be added to the category in the future.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.