By April 1, state Medicaid agencies must start reimbursing pharmacies for prescription drugs based on actual acquisition costs. It previously based payment on the ingredient costs for a drug and a dispensing fee for filling the prescription.
The CMS says the change will more accurately reflect pharmacies’ purchase prices. The rule also requires states to provide the CMS with data that show their reimbursement methodology represents actual acquisition costs. The new regulations come nearly six years after an initial proposed rule was withdrawn in 2010 because it conflicted with sections of the Affordable Care Act. The CMS then released a second version of the draft regulations in February 2012.