National Average Drug Acquisition Cost (NADAC) Information
As you may know, 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.
Click here for KanCare 90-day Fill Information - Effective July 15, 2016 (must login to view)
Maximum Allowable Cost Information
In the last couple of issues of the KPhA e-Communiqué, we informed you that during the 2016 Kansas Legislative Session, Sub for Senate Bill 103 or our "MAC Transparency Law" was passed by the Kansas Legislature and signed into law by the Governor. The question you may have is how does this legislation affect you and your pharmacy profitability?
As we've previously written, this legislation has some specific requirements for pharmacy benefit management companies to follow:
Other key provisions of the bill can be read in this short summary. During the legislative process, KPhA made it known to the legislature that there were no enforcement mechanisms in this legislation, hence no incentives for the PBMs to follow the law. Key legislators acknowledged that fact and told us that if PBMs did not follow the legislation that they would consider adding enforcement mechanisms during the next (2017) legislative session.
It is difficult for us to gauge how effective this legislation has been so far. KPhA has received information on shortcomings by the PBMs from only three pharmacies. We can evaluate the effectiveness of this important legislation only through data provided by you. If you feel that a PBM is not complying with the law, we have created a form to assist you in capturing data to show this fact. It is extremely important that data be provided, because data is the only means by which we can show a legal enforcement mechanism is necessary. Pharmacy Services Administrative Organizations (PSAO) in many cases are able to assist you in quickly and easily retrieving this data. Request that your PSAO provide you this data and forward it to KPhA.
The forms that we have created are available as hyperlinks below. We also welcome data provided in a format created by your PSAO. Please be sure that there is no personally identifiable information submitted. The information captured by pharmacies and presented in these forms will help KPhA in the future if further legislative action needs to be taken.Click here to view form & submit issue
Click here for Excel File (to be able to capture multiple issues on one sheet)
Contact the KPhA office if you have any questions.