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Elizabeth M. Whitehorn, Director

Provider Notice issued 05/01/15

Reimbursement Rate Reductions Effective May 1, 2015 through June 30, 2015

​To: All Participating Pharmacies​
​Date: ​May 1, 2015
​Re: ​Reimbursement Rate Reductions Effective May 1, 2015 through June 30, 2015

As a result of Public Act 099-0002 (pdf), the department is required to reduce reimbursement rates paid to providers of certain services delivered on or after May 1, 2015 through June 30, 2015.  In regards to pharmacy services, this will be accomplished through a $1 reduction in dispensing fees.

Beginning with dates of service May 1, 2015, and continuing through June 30, 2015, dispensing fees will be reduced to $1.40 for brand drugs, $4.50 for generic drugs, and $11.00 for 340B drugs. Only one dispensing fee shall be paid for each 30 day supply of drugs dispensed.  For compound drugs the dispensing fee for each ingredient will be reduced by $1.

All 340B providers must bill the department their actual acquisition cost (AAC) plus the $11 dispensing fee. Providers are required to add this $11 dispensing fee to the provider charge.

These reductions apply to fee-for-service reimbursement.  If services are being provided under a Managed Care Organization (MCO) or Managed Care Community Network

(MCCN) contract, please refer to those contractual terms.

If you have questions regarding this notice, please contact a pharmacy billing consultant at 877-782-5565, Option 7.

 

 

Felicia F. Norwood

Director