As a reminder, the below paragraph was an ALERT disseminated to all pharmacy providers on October 26, 2006 and has been posted on the Agency website since that date. This policy continues to be in effect. Per Alabama Medicaid Administrative Code, Rule No. 560-X-16-.06 “Reimbursement for Covered Drugs and Services”, “usual and customary” is defined as the “charge to the general public regardless of program fees”.
In response to pharmacy retailers’ recent announcements of reduced prices for specific generic drugs, the Alabama Medicaid Agency will consider these reduced prices to be the “usual and customary” price for these retailers. Retrospective audits identifying claims that are inappropriately charging Alabama Medicaid any amount over the usual and customary amount will be recouped. Please refer to our Administrative Code Rule No. 560-X-16-.06, “Reimbursement for Covered Drugs”, as well as Provider Billing Manual Chapter 27, for more information on our reimbursement policy.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.