Pharmacy Reimbursement

Myers and Stauffer has performed more than 40 studies of pharmacy dispensing and acquisition costs in 17 states as well as several other pharmaceutical consulting engagements for state agencies and the Centers for Medicare & Medicaid Services. Currently, Myers and Stauffer sets maximum allowable cost (MAC) rates for six states.

Our expertise includes developing survey instruments, conducting desk and field reviews of information submitted by pharmacies, performing cost allocations and statistical analyses, developing reimbursement options and recommendations, and developing payment models.

We have acquired a detailed understanding of the operations of retail pharmacies, including cost structures and the relationships that are part of distribution networks. We have collected and analyzed data from thousands of pharmacies, ranging from small independent operations to the largest national chains.

We maintain online databases of current and historical drug information, including National Drug Codes (NDC), generic code number (GCN), Average Wholesale Price (AWP), Federal Upper Limits (FUL), package sizes, etc. Similarly, we maintain a database of the current and historical state reimbursement formulas and related information (e.g. co-pays) in electronic form and have built proprietary databases, covering such areas as pharmacy costs, ingredient acquisition cost by product and type of pharmacy, and third-party and cash customer revenue by product and type of pharmacy.