RA Messages for Print

RA Messages for February 15, 2000

PHARMACY PROVIDERS, PLEASE NOTE!!!

IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT THE PBM HELP DESK AT 1-800-648-0790                                   

ATTENTION PHARMACY PROVIDERS:

AS A RESULT OF A BUDGETARY SHORTFALL, THE DEPARTMENT, THROUGH AN EMERGENCY RULE, WILL CHANGE ESTIMATED ACQUISITION COST REIMBURSEMENT FOR PRESCRIPTION DRUGS TO:                                                 

  * AVERAGE WHOLESALE MINUS 15% FOR INDEPENDENT PHARMACIES AND AVERAGE  WHOLESALE PRICE MINUS 16.5% FOR CHAIN PHARMACIES FOR ALL SINGLE SOURCE DRUGS (BRAND NAME), MULTIPLE SOURCE DRUGS WHICH DO NOT HAVE A STATE MAXIMUM ALLOWABLE COST OR FEDERAL UPPER LIMIT AND THOSE PRESCRIPTIONS WHICH ARE SUBJECT TO MAC OVERRIDES BASED ON THE PHYSICIAN'S CERTIFICATION THAT A BRAND NAME PRODUCT IS MEDICALLY NECESSARY FOR A PARTICULAR RECIPIENT. THIS REIMBURSEMENT CHANGE IS  EFFECTIVE FOR SERVICES BEGINNING FEBRUARY 1, 2000. CHAIN PHARMACIES ARE DEFINED AS MORE THAN FIFTEEN MEDICAID ENROLLED PHARMACIES UNDER COMMON OWNERSHIP. ALL OTHER MEDICAID ENROLLED PHARMACIES ARE DEFINED AS INDEPENDENT PHARMACIES.

EFFECTIVE FOR DATES OF SERVICE BEGINNING FEBRUARY 1, 2000, LOUISIANA MEDICAID WILL LIMIT PAYMENTS FOR PRESCRIPTION DRUGS TO THE LOWER OF:   

  * ESTIMATED ACQUISITION COST WHICH IS DEFINED AS AVERAGE WHOLESALE PRICE MINUS 15% FOR INDEPENDENT PHARMACIES AND AVERAGE WHOLESALE  PRICE MINUS 16.5% FOR CHAIN PHARMACIES FOR ALL SINGLE SOURCE DRUGS (BRAND NAME), MULTIPLE SOURCE DRUGS WHICH DO NOT HAVE A STATE MAXIMUM ALLOWABLE COST OR FEDERAL UPPER LIMIT AND THOSE PRESCRIPTIONS WHICH ARE SUBJECT TO MAC OVERRIDES BASED ON THE PHYSICIAN'S CERTIFICATION THAT A BRAND NAME PRODUCT IS MEDICALLY NECESSARY FOR A PARTICULAR RECIPIENT PLUS THE MAXIMUM ALLOWABLE OVERHEAD COST (DISPENSING FEE);                                                  

  * LOUISIANA MAXIMUM ALLOWABLE COST LIMITATION PLUS THE MAXIMUM ALLOWABLE OVERHEAD COST;                                                 

  * FEDERAL UPPER LIMIT PLUS THE MAXIMUM ALLOWABLE OVERHEAD COST; OR   

  * PROVIDER'S USUAL AND CUSTOMARY CHARGE TO THE GENERAL PUBLIC.       

PLEASE MAKE THE FOLLOWING CHANGES TO THE 8/15/98 VERSION OF APPENDIX A:

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.