January 29, 2014—Texas Medicaid proposes to stop requiring health care providers to bill it for 340B drugs at actual acquisition cost (AAC) and to begin reimbursing providers instead based on its best estimate of a drug’s 340B price plus a dispensing fee. [ms-protect-content id=”2799″]
The Texas Health and Human Services Commission (HHSC) outlined the change in a Jan. 3 proposed rule. It is holding a public hearing on its proposal today and accepting comments through Feb. 1.
HHSC noted in the proposed rule’s preamble that some 340B covered entities, particularly hospitals with outpatient pharmacies, “have expressed difficulty being able to meet the current requirement” for billing at AAC.
The new rule reportedly will apply only to fee-for-service retail 340B claims. It also reportedly will allow covered entities to bill at their usual and customary rates, which would free entities from having to maintain a separate price list for billing Medicaid for 340B drugs. Providers have expressed concern about the burden involved in how they must bill Medicaid.
The rule’s preamble states that HHSC is still deciding how it will estimate a drug’s 340B price, and that this new reimbursement methodology will not change how the state sets its dispensing fee. The state’s dispensing fee for all retail drugs, whether 340B-eligible or not, is currently $6.50. Texas Medicaid provides additional incentives that can make the dispensing fee higher than $6.50. For example, the state pays an incentive fee for prescriptions filled with preferred generic drugs.
If the new rule is adopted, “Medicaid providers enrolled in the 340B program will be able to more easily submit accurate claims, which may encourage more providers to enroll in the program,” HHSC said. [/ms-protect-content]