Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XXIX - Pharmacy › Chapter 9 - Methods of Payment › Subchapter E - 340B Program › Section XXIX-961 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
Actual Acquisition Cost-
the covered
					 entitys net payment made to purchase a drug product.
Contract Pharmacy
-a pharmacy under
					 contract with a covered entity that provides services to the covered entitys
					 patients, including the service of dispensing the covered entitys 340B drugs,
					 in accordance with Health Resources and Services Administration (HRSA)
					 guidelines (75 FR 10272, March 5, 2010). Contract pharmacies are not allowed to
					 bill Medicaid for pharmacy claims.
Covered Entity-
a provider or program that
					 meets the eligibility criteria for participating in the 340B Program as set
					 forth in section 340B(a)(4) of the Public Health Service Act. Covered entities
					 include eligible disproportionate share hospitals that are owned by, or under
					 contract with, state or local government, community health centers, migrant
					 health centers, health centers for public housing, health centers for the
					 homeless, AIDS drug assistance programs and other AIDS clinics and programs,
					 black lung clinics, hemophilia treatment centers, native Hawaiian health
					 centers, urban Indian clinics/638 tribal centers, 340s school-based programs,
					 Title X family planning clinics, sexually-transmitted disease clinics and
					 tuberculosis clinics.
Dispensing Fee
-Repealed.
Estimated Acquisition Cost (EAC)
-the
					 national average drug acquisition cost (NADAC) of the drug dispensed. If there
					 is not a NADAC available, the EAC is equal to the wholesale acquisition cost,
					 as reported in the drug pricing compendia utilized by the departments fiscal
					 intermediary.
Medicaid Carve-Out-
a billing mechanism
					 available to covered entities that implements the 340B requirement protecting
					 manufacturers from giving a 340B discount and paying a Medicaid rebate on the
					 same drug. If a covered entity elects to implement the Medicaid carve-out
					 option, the covered entity only purchases through the 340B Program covered
					 drugs dispensed to non-Medicaid patients; drugs dispensed to Medicaid patients
					 are purchased outside the 340B Program.
Patient-
an individual eligible to receive
					 340B-discounted drugs from a covered entity by virtue of being the covered
					 entity's patient as defined in HRSA's 1996 patient definition guideline (61 FR
					 55156, October 24, 1996).
Professional Dispensing Fee-
the fee paid
					 by Medicaid for the professional services provided by a pharmacist when
					 dispensing a prescription. Per legislative mandate, the $0.10 provider fee
					 assessed for each prescription filled in the state of Louisiana will be paid
					 separately.
Wholesale Acquisition Cost (WAC)-
the
					 manufacturers published catalog price for a drug product to wholesalers as
					 reported to Medicaid by one or more national compendia on a weekly
					 basis.
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.