Covered Entity Pharmacies
340B Covered Entity Pharmacies (excludes contracting pharmacies) who are listed on the MEF and fill Medicaid member prescriptions with drugs purchased at the prices authorized under Section 340B of the Public Health Services Act.
340B Covered Entity pharmacies will be required to bill Medicaid at actual acquisition cost (AAC). Medicaid reimbursement will include the AAC, not exceeding 340B Ceiling Price, plus a dispensing fee. (The dispensing fee is $10.50.)
Managed Care Organizations (MCOs)
340B Covered Entity pharmacy claims are paid the same as Non-340B pharmacy claims.
Covered Entity contract pharmacies should not dispense drugs acquired through the Federal 340B drug price program to Medicaid patients. Contract Pharmacy claims will be included for drug rebates.
Physician Administered Drugs (PADS): These claims are excluded from the rebate at the 340B MEF provider level. It is important that 340B covered entities and their providers sign up on the HRSA OPA website for themselves and their Covered Entity Pharmacies, using their KMAP ID and NPI.