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Provider Notice Issued 06/04/2021
Date: June 4, 2021
To: All Medical Assistance Program Providers
Re: Correction for Reporting ActualAcquisition Cost on Managed Care Plan Claims for ProvidersParticipating in the 340B Program
This providernotice is a follow-up to the April15, 2021 notice concerning billing requirements for providers participating in the340B program.
The April 15, 2021 provider notice stated the information in the notice applies to claims submittedto the Department of Healthcare and Family Services (HFS) or one of theMedicaid Managed Care Organizations (MCOs) for drugs purchased under thefederal 340B drug pricing program. This notice clarifies that reporting ofthe actual acquisition cost (AAC) for 340B program purchased drugs only appliesto fee-for-service claims submitted to the Department. It does not apply toclaims submitted to one of the MCOs.
Thiscorrection supersedes the statement in the earlier notice. All other materialin the April15, 2021 notice remains the same.
AAC information for fee-for-service claims is necessaryso that the state is able to timely and appropriately receive rebates owed tothe Department from pharmaceutical manufacturers for drugs purchased outside ofthe federal 340B program.
Nothingin this notice prohibits an MCO to require by contract that network pharmaciesreport actual 340B acquisition cost.
The Department’s 340B Drug Pricing Frequently Asked Questions has been updated toreflect the above policy and is posted to the Pharmacy webpage. Questionsregarding this notice may be directed to the Bureau of Professional andAncillary Services at 877-782-5565.
Kelly Cunningham, Administrator
Division of Medical Programs