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Pharmacy Reimbursement

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.

Reimbursement Timeline

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.

Pharmacy Reimbursement Rate Setting Vendor / Drug Reimbursement

For questions about drug reimbursement for fee for service Medicaid beneficiaries, please contact Mercer, the Pharmacy Rate Setting vendor.
Toll-free: 1-844-294-9982
Visit the Mercer website for submitting a drug rate inquiry form.


Reimbursement Archive