The adjusted Average Acquisition Cost (AAC) of generic code numbers (GCN) available in the marketplace.
The temporary vendor hired by the Department uses the following guidelines when developing and maintaining State MAC price list:
The Department currently has a State MAC program in place. The State MAC list will greatly increase in September 2011 when the new list is implemented.
The Department recognizes that changes in pharmaceutical prices and product availability occur on a regular basis. The Department will obtain and review data to ensure that State MAC rates reflect current pharmaceutical market conditions. To respond to changes in the pharmaceutical market that may impact the price and/or availability of drug products, adjustments to the State MAC list will be updated regularly. Providers should check the website for the most current list.
The Department encourages providers to review the reference materials available on the website to determine if answers are provided. If providers still have questions, comments, and input regarding the State MAC program or to request general information regarding the State MAC, contact Colorado.SMAC@hcpf.state.co.us.
Providers are encouraged to contact ACS PA Helpdesk at 800-365-4944 for Clinical and PA questions and contact Provider Services at 800-237-0044 for Payment and Reimbursement questions.
Pharmacy providers should use the Colorado State Maximum Allowable Cost (MAC) Request for Medicaid Reimbursement Review form to report to the Department issues or concerns with purchasing drugs at or below the established State MAC rate. The form can be sent via email to Colorado.SMAC@hcpf.state.co.us or faxed to (303) 866-3590 attention Pharmacy.
The Department is in process of procuring a vendor who will complete a survey to determine the cost of dispensing prescriptions in Colorado.
The rules for Colorado Medicaid Pharmaceuticals are located at 10 CCR 2505-10 8.800 MEDICAL ASSISTANCE - SECTION 8.800.12 or click here to view online
Training information is available in the Provider Bulletin. If providers have questions regarding billing process, the Department highly encourages providers to attend training.
If the client is eligible for Medicaid benefits, the client may have a co-pay. Other than the co-pay, pharmacies cannot charge Medicaid clients for the cost of any medication received.
The pharmacy can review the State MAC list available on the website to search for an NDC to see if it has a State MAC price. If there is no price available, the payment would be based on Wholesale Acquisition Cost (WAC).
Pharmacies have access to this information through their current vendor and should continue the process that is currently used with that vendor to inquire about a WAC price.
CMS is in process of providing an Average Acquisition Cost (AAC) list. Once the CMS AAC list is available, the department may use the information in determining the average acquisition price used for Colorado.
No. the pharmacy will continue to submit the claim as is done today. all calculations for reimbursement are completed when the claim reaches the state system.
Yes. The reimbursement methodology change does not affect the way any Synagis will be billed.
The price list will be posted on the website prior to the implementation of the new pricing methodology.
It will not. The pharmacy should continue to submit the compound claim as is done today. All calculations for reimbursement are completed when the claim reaches the state system.
All Compound Claims are paid one dispensing fee and ingredients are paid based on each line item billed. This will not change.