Medicaid has proposed a new default reimbursement methodology if no AAC exists for a drug product. Currently, if no AAC exists, the alternative is WAC+0%. Medicaid is suggesting a change to WAC-4% for brand drugs only. Comments on the proposal are due at 12:00 noon on Friday, October 11.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
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.
Medicaid issued an alert announcing effective Friday, February 1, the agency will begin reimbursing Medicaid-enrolled pharmacy providers for the administration of hepatitis A vaccine to eligible recipients ages 19 years and older. Medicaid will, in addition to the administration reimbursement, reimburse pharmacies for the hepatitis A vaccine.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Effective Thursday, November 1, the Medicaid Agency will begin implementing limits on short-acting opiates for opioid naíve recipients. Details are available on the website. Also, the override form and criteria have been posted. Additionally, prescribers and pharmacists may access the printable Recipient Information Sheet online.
Medicaid conducted an information session on June 13 regarding its proposed “Pivot Entity” (Alabama Coordinated Health Network) Initiative that builds off the Agency’s current case management program structure. A copy of the slides and the video presentation by Medicaid Medical Director Robert Moon has been posted on the Agency’s website. The webpage also includes a summary of the proposed project, which is subject to approval by CMS, and an email address to submit questions or comments. Important note: The proposed “Pivot Entity” program is designed to create a single care coordination delivery system that effectively links patients, providers and community resources in each of seven newly-defined regions. Delivery of medical services is not part of this program.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Medicaid Agency is pursuing a new initiative to transform the Medicaid delivery system through a flexible and more cost-efficient effort which builds off the Agency’s current case management program structure. A meeting to discuss this initiative will be held on Wednesday, June 13. The meeting is for providers, recipients, advocates and others with an interest in Medicaid.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Medicaid is proposing to make a small change in the 271 Eligibility response, but would like to gauge impact to vendors before making the change. If you utilize the 271 Eligibility response, either real-time or batch, please have your software vendor or clearinghouse fill out the following brief survey so that Medicaid staff can determine the potential impact of the proposed change. The survey needs to be completed by Wednesday, May 9.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.