IPC Member Participation Crucial in States Renewing Cost To Dispense Surveys for Medicaid Outpatient Drug Professional Fee Calculation

Oct 17, 2018

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.

It is imperative for you to fill out any COD survey request for your store that you receive in 2018 and 2019 from your state Medicaid program. The more accurate and complete COD surveys that a state Medicaid program receives from independent pharmacies, the more likely you will receive a higher COD fee for state Medicaid FFS claims. Also, these FFS COD fee rates  are important as more states are looking to either carve back in or use this transparent prescription claims formula as a transparent requirement for Medicaid managed care prescription reimbursement payments.

You should seek the help of your PSAO, accountant and possibly your attorney in order to accurately and completely fill out this state Medicaid survey. If you have questions about this program, please contact either IPC’s Government Relations Department at government.relations@ipcrx.com, the IPC Pharmacy Services team or your IPC representative.