Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 29 - Division of Medical Services › Rule 016.29.22-014 - 340B Modifiers on Physician Administered Drugs

Current through Register Vol. 49, No. 6, June, 2024
212.212
(DME) Specialized
			 Rehabilitative Equipment, Two (2) Years of Age and Older
Arkansas Medicaid covers specialized rehabilitative equipment
				for Medicaid-eligible beneficiaries two (2) years of age and older.
Some items of specialized equipment require prior authorization
				from DHS or its designated vendor. View or print form DMS-679A and instructions
				for completion. View or print contact information for how to submit the
				request.
212.213
(DME)
			 Specialized Wheelchairs and Wheelchair Seating Systems for Individuals Two (2)
			 Years of Age and Older
Arkansas Medicaid covers specialized wheelchairs and wheelchair
				seating systems for individuals two (2) years of age and older.
Some items of specialized equipment require prior authorization
				from DHS or its designated vendor. View or print form DMS-679 and instructions
				for completion. View or print contact information for how to submit the
				request.
217.000
Federal Public Health Service's 340B Drug Pricing Program
All covered entities that participate in the Federal Public
				Health Service's 340B Drug Pricing Program that carve Arkansas Medicaid into
				the 340B program are required to bill Arkansas Medicaid using their 340B Actual
				Invoice Price for drugs.
A. Covered
			 entities that bill Arkansas Medicaid for physician administered drugs,
			 including specialty drugs, are required to bill Arkansas Medicaid using their
			 340B Actual Invoice Price.
B.
			 Pharmacies are required to bill Arkansas Medicaid using their 340B Actual
			 Invoice Price for Covered Legend and non-legend drugs, including specialty
			 drugs, purchased through the Federal Public Health Service's 340B Drug Pricing
			 Program. The 340B covered entity pharmacies that carve Medicaid into the 340B
			 Drug Pricing Program will be reimbursed the lesser of the 340B Actual Invoice
			 Price or the 340B ceiling price [provided or calculated by Average Manufacturer
			 Price (AMP) minus Unit Rebate Amount (URA)] plus the established professional
			 dispensing fee, minus the beneficiary's copayment. The 340B actual invoice
			 price for each drug reimbursement covered under this program must be submitted
			 to the Department prior to any claims being processed. The 340B pharmacies will
			 identify on claim submission using the National Council for Prescription Drug
			 Programs (NCPDP) indicator for drugs purchased through the 340B program. Drugs
			 purchased outside the 340B program shall be submitted without the NCPDP 340B
			 claim indicator and will be reimbursed using the lesser of methodology plus the
			 established professional dispensing fee minus the beneficiary's copayment. All
			 applicable federal and state supplemental rebates will be applied to claims
			 submitted without the NCPDP 340B claim indicator. The State will not recognize
			 340B contract pharmacies. The 340B contract pharmacies are required to carve
			 Medicaid claims out of the 340B Drug Pricing Program. Claims exceeding the 340B
			 ceiling price as published or calculated by Average Manufacturer Price (AMP)
			 minus Unit Rebate Amount (URA) will be subject to audit and may reject at point
			 of sale.
Pharmacy providers who submit NCPDP claims to the Arkansas
				Medicaid Program on or after January 1, 2012, will be required to send value
				07, 08, or 13 in the Basis of Cost Determination field (423-DN). The 340B
				providers have contractual agreements with federally qualified 340B entities,
				enabling special purchase of medication at federal bid pricing. These
				medications are reserved for only beneficiaries meeting the federal definition
				of 340B patients. Claims for prescriptions filled with medications purchased
				through the 340B program will carry the 08 value (340B Pricing) in the Basis of
				Cost Determination Field. Claims submitted with usual and customary pricing
				will carry the 07 value (Usual and Customary Pricing) in this field. Claims for
				prescriptions filled with non-340B purchased medication AND given a special
				price will carry the 13 value (Special Pricing) in this field.