1. 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.