2019 Session

Budget Amendments - SB1100 (Member Request)

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Chief Patron: McDougle
Minimum Pharmacy Reimbursement Requirements for Managed Care (language only)

Item 303 #25s

Item 303 #25s

Health and Human Resources
Department of Medical Assistance Services


Page 342, after line 27, insert:

"YYY.  As a condition of this appropriation, effective on or before July 1, 2019, the Department of Medical Assistance Services shall provide that in all prescriptions under any of the department's programs that: (i) the cost of drug reimbursement shall not be below the amount calculated using the National Average Drug Acquisition Cost - to determine ingredient cost; and (ii) a dispensing fee of $10.65 per prescription is paid to any retail pharmacy, hospital or long­ term care facility, mail order pharmacy or other dispenser of prescription drugs through direct reimbursement or through its managed care organization contracts. No back-charge, claw-back, surcharge or other arrangement shall reduce or offset this dispensing fee other than as a result of fraud. The department shall ensure by July 1, 2019, that the department and every managed care organization provide in all contracts with any pharmacy benefit manager or other subcontractor that the dispensing fee is a pass-through to the dispenser without offset or reduction by such subcontractor."


(This amendment requires the Department of Medical Assistance Services to ensure a minimum reimbursement to pharmacies in the Medicaid program to at least cover the costs of dispensing.)