Last week, CMS approved the state’s application to direct a state-funded supplemental dispensing fee of $4.50 to pharmacies not owned by a PBM and located in HRSA (Health Resources and Services Administration) medically underserved areas. The $4.50 per prescription payments apply to Medicaid Managed Care prescriptions filled on or after July 1, 2025. The program is a result of a 2025 state budget provision NACDS helped develop as a safety net for pharmacies until cost-based reimbursement is implemented under the Single PBM model. NACDS will continue collaborating with the Department of Health and Human Services while they develop the state’s application and disbursement procedures, with an eye on maximizing member participation. In addition, NACDS is supporting current legislation that would amend the law to continue the payments until the Single PBM delayed implementation date in 2028.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.