AR Reimbursement Methodology and NADAC - Arkansas
Arkansas Medicaid Reimbursement Methodology and NADAC
Effective April 1, 2017, Arkansas Medicaid will be utilizing a new pricing methodology for the reimbursement of covered outpatient legend and non-legend drugs. CMS has mandated that all state Medicaid programs can no longer utilize AWP pricing and must move towards a more accurate actual acquisition cost methodology. The Arkansas Medicaid lesser of methodology will price claims off Usual and Customary, National Average Drug Acquisition Cost (NADAC) rates (in cases where the NADAC is terminated or is not reported, WAC may be used as a backup) and all ACA FUL rates and SAAC (State Actual Acquisition Cost previously referred to as State MAC) rates will still apply. The Professional Dispensing Fee will be increased to $9 for Brand and Non-Preferred Brand drugs and $10.50 for Generics and Brand Preferred drugs. Claims submitted for a date of service on or after 04/01/2017 will use the new pricing methodology and dispensing fees. Claims submitted for a date of service prior to 04/01/2017 will use the old pricing methodology (AWP) and dispensing fee ($5.51). Please refer to Section II of the Pharmacy Provider Manual to view the fully detailed reimbursement methodology.
ACA FUL rates are updated monthly and NADAC rates are calculated monthly but can change on a weekly basis. NADAC rates that potentially change are released on Wednesdays. Most common reasons a NADAC may change weekly instead of monthly may be due to provider inquiry to the NADAC Help Desk or the WAC rate changes on a brand drug which triggers the Brand NADAC to be recalculated. Arkansas Medicaid gets the drug file reported to them on a weekly basis from First Data Bank and is generally loaded on Saturday nights. The effective date of any ACA FUL or NADAC on the file will be backdated in our system to reflect the effective date on the weekly drug file in which it was reported. If a NADAC rate is published on 04/12/2017 that has an effective date of 04/01/2017, when Arkansas Medicaid loads the drug file the following weekend on 04/15/2017, we will load the retro effective date of 04/01/2017 so that any claim can be resubmitted by the provider manually to process off the updated rate.
All ACA FUL and NADAC rates are available for anyone to view at https://www.medicaid.gov/medicaid/prescription-drugs/pharmacy-pricing/index.html
To aid pharmacy providers, Arkansas Medicaid has created an informational sheet on the NADAC Request for Medicaid Reimbursement Review form below. This informational sheet is not affiliated to Myers and Stauffer LLC in any way as it is just an aid and should not be submitted to the NADAC Help Desk as part of their review inquiry. All NADAC forms needs to be submitted to Myers and Stauffer LLC but copied to Arkansas Medicaid to prove you have filed your issue with Myers and Stauffer LLC.
NADAC Help Desk:
Toll-free phone: (855) 457-5264
Facsimile: (844) 860-0236