On September 26, NACDS participated in a Medicaid meeting/conference call, during which the agency discussed potential pharmacy reimbursement modifications. In accordance with current market evidence, the agency proposed modifying the default reimbursement methodology from WAC + 0% to WAC – 4%, if no AAC exits for a drug product. Medicaid asked for all stakeholders to submit comments; those comments and responses, along with all other items discussed that day, may be found on the website. On November 15, the agency announced its plan to move forward with a State Plan Amendment (SPA) for the proposed change.  

Also in Alabama… A reminder that gabapentin became a Schedule V medication on November 18. You may recall on May 15, the State Committee of Public Health voted to change gabapentin to a Schedule V medication, effective November 18, 2019. This was at the request of the Board of Medical Examiners. Pharmacies should have completed the necessary changes required when moving a legend medication to a scheduled medication. These changes may include software requirement changes, increases in physical space to store scheduled medications and changes in procedures for prescribing/dispensing a controlled substance. Questions can be directed to Nancy Bishop, State Pharmacy Director, Department of Public Health.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Effective December 2, 2019, the Alabama Medicaid Agency will implement hard edits on cumulative daily MME claims exceeding 200 MME/day. A phase-in period for claims exceeding 150 MME/day, but less than 200 MME/day, will also be implemented. For more information please see the Medicaid Alert dated November 4, 2020.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

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.