Agencies
Services
Provider Notice issued 12/15/08
To: Participating Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Encounter Rate Clinics (ERCs), Hospitals, Local Education Agencies (LEAs), Local Health Departments, School Based/Linked Health Centers, Pharmacies and Physicians
Date: December 15, 2008
Re: 340B Providers
This is an important reminder that all providers who are enrolled as 340B providers with the US Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA), must charge HFS no more than their actual acquisition cost for drugs dispensed or administered to HFS clients.
Section 340B of the Public Health Service Act limits the cost of covered outpatient drugs to certain federal grantees, federally-qualified health center look-alikes, and qualified disproportionate share hospitals. These providers purchase pharmaceuticals at significantly discounted prices. These providers are referred to as 340B providers.
In addition to reimbursement for ingredient, HFS allows pharmacies a dispensing fee of $3.40 for brand name drugs, and $4.60 for generic drugs. HFS-enrolled pharmacies who are enrolled with HRSA as 340B providers should charge HFS no more than their actual acquisition cost for the product, plus the appropriate dispensing fee, based on the brand/generic status of the drug. The sum of the actual acquisition cost plus the appropriate dispensing fee should be entered in the NCPDP usual & customary charge field (426-DQ) on electronic pharmacy claims.
Provider types other than pharmacies should bill HFS no more than their actual acquisition cost for the drug.
Questions regarding this notice may be directed to the Bureau of Pharmacy Services at 1-877-782-5565, Option 7.
Theresa A. Eagleson, Administrator
Division of Medical Programs