Staff Contact: Brian Kinkade
The MO HealthNet Division updated its pharmacy provider manual with the changes in 340B reimbursement that are scheduled to take effect Thursday, July 1. The policy manual essentially is the same as the provider bulletin issued on the subject last week.
On and after July 1, 340B providers carving-in for Medicaid must submit retail and specialty pharmacy claims with Submission Clarification Code 20, which will be reimbursed at the 340B ceiling price or the providers’ actual acquisition cost if lower, plus the standard professional dispensing fee. The providers also must submit medical and outpatient claims for physician-administered drugs with a JG or TB modifier, and will be reimbursed at the 340B ceiling price plus 6%, not to exceed $600. No dispensing fee is paid on physician-administered drugs.
The change is a general decrease in reimbursement for 340B drugs, and partly is driven by changes in federal law from 2017. MHA has argued that the state’s application is overly broad in that the directive that state Medicaid programs limit 340B reimbursement to actual acquisition cost does not extend necessarily to physician-administered drugs. The state agency is choosing to apply the principle to physician-administered drugs nonetheless.