A new pharmacy reimbursement methodology for the Mississippi Division of Medicaid (DOM) impacts both fee-for-service and MississippiCAN pharmacy claims. This page covers the current pharmacy reimbursement timeline in addition to providing specific information regarding stakeholder meetings, pharmacy reimbursement methodology as found in the State Plan Amendment (SPA), specialty drug list, and the 340B program.
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).
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.
Implementation of the CMS approved point of sale pharmacy reimbursement methodology for fee for service and MississippiCAN will begin on September 1, 2017.
- Revised Reprocessing Schedule Notice – Sept. 8, 2017
- Pharmacy Reimbursement Methodology
- Provider Public Notice and Claims Reprocessing Schedule
- Stakeholder Meetings
- NADAC Help Desk Information
Pharmacy Reimbursement Rate Setting Vendor
For questions about drug reimbursement for fee for service Medicaid beneficiaries, contact the Myers & Stauffer LC Pharmacy Rate Setting call center.
Visit the Myers and Stauffer website for more information concerning drug reimbursement or the specialty drug list.
Drug Reimbursement / Specialty Drug List
For questions about specific drug reimbursement, contact the Myers and Stauffer, LC Rate Setting call center.
Fax: (317) 571-8481
Email: MSPharmacy@mslc.com Visit the Myers and Stauffer website for more information concerning drug reimbursement and to view or download the current specialty drug list.
Please click here for archived Specialty Drug Lists.
- Pharmacy reimbursement eff. July 1, 2005 – March 31, 2017