As outlined in California's State Plan Amendment 17-002, DHCS is implementing a new FFS reimbursement methodology for covered outpatient drugs. Barring unforeseen delay, DHCS anticipates FFS pharmacy providers will see the new reimbursement methodology reflected in their claims with dates of service starting February 23, 2019. Because the policy effective date mandated by CMS is April 1, 2017, DHCS intends to make retroactive adjustments for all claims with dates of service between April 1, 2017, and the implementation date.

IPC’s Government Relations team encourages members in the Texas area to attend the Texas Pharmacy Day at the Capital. The event will take place Tuesday, February 26th at First United Methodist Church in Austin, Texas. Presented by the Alliance of Independent Pharmacists of Texas, the goal is to unite multiple independent pharmacy interests on legislative and regulatory issues, while promoting the profession. Register online at www.aiptexas.org today!

State Medicaid programs, now in their second year of utilizing the federally mandated program to pay for Medicaid fee for service (FFS) prescription claims of an actual acquisition cost (AAC) for the drug ingredient (mostly federal NADAC pricing) and a survey-based, cost to dispense (COD) professional dispensing fee (PDF), are beginning the process this year to survey pharmacies of their Medicaid prescription dispensing costs to update their COD fee. Many states have state laws to require pharmacies to participate in these surveys which occur usually every two years.

We are in the final stages of the legislative process for AB 315 (Wood, Dahle, Nazarian & Stone) which would require that Pharmacy Benefit Managers (PBMs) be regulated by the California Department of Managed Health Care (DMHC). Voting will take place as early as Monday, August 27th.

IPC Chairman of the Board, Chris Darling, recently had a visit from Congressman Glenn Thompson!

OH Medicaid Orders All Ohio MCOs to Terminate PBMs Using Spread Pricing; Must Switch to Pass Through Pricing PBM Contracts. Creates Big Improvement Opportunity for MCO Pharmacy Reimbursement