Drug Topics - March 17, 2008 - (Page 5) 5 Medicaid Prescription Reimbursement Information by State—Qtr Ending December 2007 State Ingredient cost Dispensing fee Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine WAC +9.2% then AWP-10% AWP-5% AWP-15% AWP-20% (generic); AWP-14% (brand) AWP-17% AWP-35% (generic); AWP-13.5% (brand) AWP-40% (generic); AWP-14% (brand) AWP-14% (traditional - retail independent & retail chain pharmacies); AWP-16% (non-traditional -long term care & speciality pharmacies) AWP-10% Lower of AWP-15.45%; WAC+5.75%; FUL or SMAC AWP-11% AWP-10.5% AWP-12% AWP-25% (generic); AWP-12% (brand) AWP-20% (generic); AWP-16% (brand) AWP-12% AWP-27% (generic); AWP-13% (single source); AWP-13% (brand) AWP-12% AWP-13.5% (AWP-15% for chains) AWP-15%; direct supply drug list-usual & customary charge or AWP-17% plus $3.35 professional fee or FUL or MAC plus $3.35 professional fee (Mail order lowest of usual & customary charge, AWP-20% plus $1.00 professional fee-for exceptions see State plan, FUL or MAC plus $1.00 professional fee) Lower of AWP-12% or WAC+8%, direct price+8% or distributor price when available WAC+5% AWP-13.5% (independ pharm: 1-4 stores); AWP-15.1% (chain: 5+ stores) AWP-11.5% Lower of brand: FUL, AWP-12%, WAC+9%; generic: FUL, AWP-25% Lower of AWP-10.43% or WAC+10% AWP-15% AWP-11% AWP-15% AWP-16% Lower of AWP-12.5% AWP-14% AWP-13.25% (brand); AWP-20% (generic) or the State Maximum Acquisition cost if lower; AWP-12% (specialized HIV pharmacies) AWP-10%, ASP+6% Lower of AWP-10%, WAC+12.5% WAC+7% or its equivalent, AWP - 14.4% AWP-12% AWP-11% (institutional), AWP-15% (noninstitutional) Lower of WAC +6%, AWP -15% WAC AWP-10% AWP-10.5% AWP-13% Lower of AWP-15% or WAC+12% AWP-15% AWP-11.9% AWP-10.25% $5.40 $3.45-$11.46 (based on pharmacy/Medicaid volume) $2.00 (FFS only) $5.51 $7.25; $8.00 (legend - skilled nursing & intermediate care facilities) $4.00 (retail pharmacy); $1.89 (institutional pharmacy) $3.60 $3.65 $4.50 $4.23 (regular pharmacies); $7.50 (qualified 340B entities/ingredient cost) $4.63 (brand for profit pharm); $4.33 (brand not for profit); $5.13 (generic for profit pharm); $4.63 (generic not for profit) $4.67 $4.94 ($5.54 for unit dose) $4.60 (generic); $3.40 (brand) $4.90 $4.26 $3.40 $4.51 $5.77 $3.35; $4.35 & $5.35 (compounding); $12.50 (insulin syringe) Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming REVISED 12/28/2007 $3.69 (generic); $2.69 (brand); $4.69 (generic-NH); $3.69 (brand-NH); $7.25 (home IV therapy) $3.50 (single source), $5 (multiple source); $10 (340B drugs) $2.50; $2.75 (long term care) $3.65 (+$.50 for legend unit dose drugs) $3.91 (brand); $4.91 (generic); $3.91 (long term care) $4.09 $4.70 $3.27-$5.00 (based on service delivery, unit dosage or 3rd party payors) $4.76; $22.40 daily (home IV therapy); $16.80 daily (NF home IV therapy) $1.75 $3.73; $4.07 (addt’l services) $3.65 $4.50 (generic); $3.50 (brand) $5.60 (generic); $4.00 (brand) $5.60 (generic); $4.60 (brand) $3.70 $4.15 $3.50 (retail); $3.91 (institutional) $4.00 $3.40 (outpatient), $2.85 (long term care) $4.05 (independ pharm); $3.15 (institutional) $4.75 ($5.55 for unit dose) $2.50 (long term care dual eligib); $5.00 (NH only-if 28 days+) $5.14 $3.90 (urban); $4.40 (rural) In-State - $4.75 Out-of-State-$3.65 $4.00 (brand); $4.00 (generic); $5.00 (unit dose drugs) AWP-14% (single source & multiple source (w/2-4 manufact)), AWP-50% (multiple $4.20-$5.20 (based on 3-tiered pharmacy volume); $3.25 (mail order) source from 5+ manufact), AWP-19% (brand-mail order), AWP-15% (generic-mail order) AWP-15% (brand), AWP-30% (generic) AWP-11.25% AWP-11% $2.50 (brand); $5.30 (generic); $8.25 (340B drugs) $4.88 $5.00 SOURCE: Centers for Medicare & Medicaid Services Approved State Plans (ASP=avg sale price, AWP=avg wholesale price, WAC=wholesaler acquisition cost, NH=nursing home)
Table of Contents Feed for the Digital Edition of Drug Topics - March 17, 2008 Drug Topics - March 17, 2008 Contents Commonly Confused Drug Pairs Medicaid Prescription Reimbursement Information By State ACP Issues Guidance On Optimal HbA1c for Type 2 Diabetics Latest News Roundup Drug Topics - March 17, 2008 Drug Topics - March 17, 2008 - Contents (Page 1) Drug Topics - March 17, 2008 - Contents (Page 2) Drug Topics - March 17, 2008 - Commonly Confused Drug Pairs (Page 3) Drug Topics - March 17, 2008 - Commonly Confused Drug Pairs (Page 4) Drug Topics - March 17, 2008 - Medicaid Prescription Reimbursement Information By State (Page 5) Drug Topics - March 17, 2008 - ACP Issues Guidance On Optimal HbA1c for Type 2 Diabetics (Page 6) Drug Topics - March 17, 2008 - ACP Issues Guidance On Optimal HbA1c for Type 2 Diabetics (Page 7) Drug Topics - March 17, 2008 - Latest News Roundup (Page 8) Drug Topics - March 17, 2008 - Latest News Roundup (Page 9)
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