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Provider Notice Issued 06/04/2021

Date:   June 4, 2021

 

To:       All Medical Assistance Program Providers

 

Re:      Correction for Reporting Actual Acquisition Cost on Managed Care Plan Claims for  Providers Participating in the 340B Program

 

 

This provider notice is a follow-up to the April 15, 2021 notice concerning billing requirements for providers participating in the 340B program.

 

The April 15, 2021 provider notice stated the information in the notice applies to claims submitted to the Department of Healthcare and Family Services (HFS) or one of the Medicaid Managed Care Organizations (MCOs) for drugs purchased under the federal 340B drug pricing program. This notice clarifies that reporting of the actual acquisition cost (AAC) for 340B program purchased drugs only applies to fee-for-service claims submitted to the Department. It does not apply to claims submitted to one of the MCOs.

 

This correction supersedes the statement in the earlier notice. All other material in the April 15, 2021 notice remains the same. 

 

AAC information for fee-for-service claims is necessary so that the state is able to timely and appropriately receive rebates owed to the Department from pharmaceutical manufacturers for drugs purchased outside of the federal 340B program.

 

Nothing in this notice prohibits an MCO to require by contract that network pharmacies report actual 340B acquisition cost.

 

The Department’s 340B Drug Pricing Frequently Asked Questions has been updated to reflect the above policy and is posted to the Pharmacy webpage. Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.

 

 

 

Kelly Cunningham, Administrator

Division of Medical Programs​


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JB Pritzker, Governor • Theresa Eagleson, Director