On April 1, 2016 the Kansas Medicaid program (KanCare) instituted a new pricing methodology for the managed-care organization (MCO) plans. Under this model, reimbursement of pharmacy claims are computed using the National Average Drug Acquisition Cost (NADAC) survey compiled by the actuarial firm Myers and Stauffer. Myers and Stauffer is the organization that should be sent all pricing appeals.
This can be done by calling their toll-free help desk: 855-457-5264 or by email at email@example.com.
Surveys are sent to random pharmacies on a regular basis by Myers and Stauffer. Please be sure to complete any survey you may receive! The surveys are used to compute NADAC pricing for all pharmacies. The results are available to the public and uploaded weekly on the Medicaid website.
So that we can gauge the success of this new program, the Kansas Pharmacists Association would like to document reimbursements that are incorrect or inconsistent using NADAC pricing. Please let us know of these errors by completing the NADAC form KPhA created. You must be a KPhA member to utilize this option. Pricing appeals should still be sent to Myers and Stauffer at the email address or toll-free number above.
Click here to login to the KPhA website and complete the form and for other NADAC resource help.
New Pharmacy Prior Authorization Form
Click here for KanCare 90-day Fill Information - Effective July 15, 2016 (must login to view)