Pharmacy Reimbursement and Manufacturer Rebate Formulas (Part 3)

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Presentation transcript:

Pharmacy Reimbursement and Manufacturer Rebate Formulas (Part 3) State Brand Formula Generic Formula FUL State MAC List Dispensing Fee Base Rebate Formula Medicaid Best Medicaid CPI Adjustment SC AWP – 10% N Y $4.05 OBRA 90 Rebate Formula VT AWP – 11.9%, FUL, MAC or U&C AWP – 11.9%, FUL, MAC or U&C $4.25 Same as Medicaid WI AWP – 12% MAC $4.88 Standard CMS URA formula WY AWP – 11% $5.00 less AWP = Average Wholesale Price, FUL = Federal Upper Limit, (F)MAC = (Federal) Maximum Allowable Cost, SMAC = State Maximum Allowable Cost, EAC = Estimated Actual Cost, WAC = Wholesale Acquisition Cost, URA = Unit Rebate Amount, U&C = Usual and Customary Reductions. Notes: Data for Maine and Michigan are from 2002.