Font Size
-
+

Reimbursement options

On February 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. The document is available online at http://federalregister.gov/a/2016-01274.

On March 8, 2016, the Division of Medicaid (DOM) held an initial Pharmacy Stakeholder meeting for the purpose of reviewing CMS-2345-FC.

On May 19, 2016, Division of Medicaid (DOM) held a Pharmacy Stakeholder Meeting to provide viable reimbursement options to pharmacy stakeholders.

The invited organizations included:

  • Independent Nursing Home Association (INHA)
  • Magnolia Health
  • MS Association of Community Mental Health Centers (MACMHC)
  • MS Hospital Association (MHA)
  • MS Independent Pharmacies Association (MIPA)
  • MS Pharmacists Association (MPhA)
  • MS Primary Health Care Association (MHCA)
  • MS Society of Health-Systems Pharmacists (MSHP)
  • MS State Medical Association (MSMA)
  • National Association of Chain Drug Stores (NACDS)
  • United Healthcare

In June 2016, DOM will be hosting another Pharmacy Stakeholder Meeting for stakeholders to submit questions and/or comments regarding the reimbursement options.  Please send in send your questions and/or comments to your respective organization for submission to DOM.

On June 28, 2016, Division of Medicaid (DOM) held a Pharmacy Stakeholder Meeting to address questions and/or comments from pharmacy stakeholders regarding viable reimbursement options for covered outpatient drugs in the Medicaid program.

On August 2, 2016, Division of Medicaid (DOM) held a Pharmacy Stakeholder Meeting to begin discussions regarding reimbursement options for specialty drugs in the Medicaid program.

On October 12, 2016, the Division of Medicaid (DOM) held a Pharmacy Stakeholder Meeting to gather feedback on reimbursement options for specialty drugs and hemophilia factor products.

340B Program

The 340B program is a Drug Pricing Program established by the Veterans Health Care Act of 1992, which is Section 340B of the Public Health Service Act (PHSA). Section 340B limits the cost of covered outpatient drugs to certain federal grantees, federally-qualified health center look-alikes, and qualified hospitals. These providers purchase, dispense and/or administer pharmaceuticals at significantly discounted prices. The significant discount applied to the cost of these drugs makes these drugs ineligible for the Medicaid drug rebate. State Medicaid programs are mandated to ensure that rebates are not claimed on these drugs thereby preventing duplicate discounts for these drugs.

Health Resources and Services Administration (HRSA) is specifically responsible for the enforcement of covered entity compliance with the duplicate discount prohibition. More information regarding eligibility and program logistics can be found on HRSA’s website at www.hrsa.gov/opa.

Click here for more information and resources about the 340B Program.