CMS is finalizing the Medicaid Covered Outpatient Drugs proposed rule (CMS-2345-P), which redefines drug ingredient reimbursement from a state’s best estimate of drug costs (estimated acquisition cost or EAC) to actual acquisition cost (AAC), and requires states to align their professional dispensing fee to be consistent with their ingredient cost reimbursement.
Final action on the proposed rule is expected this year. Therefore, states will need to quickly prepare for pharmacy program changes to comply with the final rule.
State Options for Redefining EAC
State Options for Evaluating Dispensing Fee
Key Considerations for Implementing AAC-based Reimbursement
Guidance for NADAC or AAC Implementation
Myers and Stauffer is highly qualified to provide guidance to your state through the implementation and maintenance of a new pharmacy reimbursement methodology that is compliant with the new requirements. Highlights of our unique expertise include:
For More Information
We encourage you to contact Lynsey Plew by email at firstname.lastname@example.org to arrange a discussion or meeting for more information regarding the NADAC, the AAC-based pricing approach, the implications of these new requirements on your program, or to answer any general questions.