Minnesota has passed legislation to come into compliance with the Centers for Medicare and Medicaid Services (CMS) Covered Outpatient Drug Rule. The goal of the CMS rule is to more closely align product reimbursement with actual acquisition cost and to change dispensing fee reimbursement to align with the true cost of dispensing. The parameters of the new rule will set FFS Medicaid product reimbursement to the National Average Drug Acquisition Cost (NADAC) and raise the dispensing fee to $10.48. The Minnesota Department of Human Services (MDHS) will then conduct cost of dispensing surveys with a revised rate recommendation to the Legislature in 2021 and will conduct a survey every 3 years. All pharmacies doing business in Minnesota are asked to provide DHS with information by July 31.
The next step in implementing the rule is for MDHS to file a State Plan Amendment (SPA) with CMS, who then reviews and approves it. In Minnesota, the SPA will be complicated by the 2% Minnesota Wholesaler Tax. MPhA has been in touch with Chad Hope, MDHS Deputy Director, Div. of Purchasing and Service Delivery, to understand what documentation all pharmacies doing business in Minnesota need to provide in order to assist CMS in making a positive decision to reimburse pharmacies for the 2% fee.
Jeff Lindoo of our Public Affairs Committee has created a template that is acceptable documentation of your payment of the 2% Wholesaler Tax to share with Dr. Hope. Dr. Hope has indicated that he believes having this documentation from nearly ALL pharmacies doing business in Minnesota will be important for CMS to make a positive decision, allowing our SPA to be approved and coming into compliance with the CMS Covered Outpatient Drug Rule. If CMS were to make a negative decision on reimbursing the 2% tax, NO PHARMACY IN MINNESOTA WOULD RECEIVE REIMBURSEMENT FOR THE 2% TAX, creating a very negative business bottom line on these claims.
Your action is needed to get this information to Dr. Chad Hope as soon as possible. Please follow the template. If you are not the appropriate person within your pharmacy operations to complete this documentation, please forward this email to the right contact point for action. As noted in the template, information can be sent directly to Dr. Hope at:
Chad Hope, PharmD
Deputy Director, Division of Purchasing and Service Delivery
Minnesota Dept of Human Services
540 Cedar Street
St. Paul, MN 55101 firstname.lastname@example.org