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Pharmacy reimbursement changes and SPA 17-0002 approval

A new pharmacy reimbursement methodology for the Mississippi Division of Medicaid (DOM) impacts both fee-for-service and MississippiCAN pharmacy claims. On Feb. 1, 2016, the Centers for Medicare and Medicaid Services (CMS) published 42 CFR, Part 447: Medicaid Program Covered Outpatient Drugs with final comments (CMS-2345-FC). This rule addresses regulations that pertain to reimbursement for covered outpatient drugs in the Medicaid program (fee for service and MississippiCAN). The document is available online and can be found by looking at the Federal Register.

DOM hosted a series of six pharmacy stakeholder meetings throughout 2016 for the purpose of engaging providers in discussions to gather feedback on pharmacy reimbursement options.

In compliance with the Final Rule issued by CMS, DOM submitted State Plan Amendment (SPA) 17-0002 Pharmacy Reimbursement to CMS on March 15, 2017. On June 1, 2017, DOM received a formal Request Additional Information (RAI) letter from CMS. DOM submitted an RAI response letter with revised SPA changes to CMS on June 27, 2017.

On July 21, 2017, CMS approved the DOM SPA 17-0002 Pharmacy Reimbursement with an effective date of April 1, 2017. The approved SPA can be found by visiting our State Plan Amendments page.

Read the notice for more information.