20 Miss. Code R. § 2-V

Current through June 25, 2024

Section 20-2-V - SPECIAL PRICING

A.Repackaged Medication:

If the only submitted National Drug Code (NDC) for the drug product as dispensed is a repackaged drug NDC, the drug will not be reimbursed. For repackaged drugs, providers shall submit both the NDC of the repackaged drug dispensed and the NDC of the original manufacturer to receive properly calculated reimbursement. Submission and placement of both NDCs shall be in accordance with the specifications of the billing form/format being used.

B.Compound Medications:

A compound medication is any customized formulation of medication prepared by a compounding pharmacist that is not commercially available and which requires a prescription. All compounded medications shall be billed by listing each individual component ingredient and each compound ingredient's NDC as assigned by the original manufacturer and calculating the charge for each component ingredient separately based on their AWP. Payment shall be based on the sum of the AWP fee for each ingredient, plus a single dispensing fee of five dollars ($5.00). Ingredients lacking an NDC will not be reimbursed. Reimbursement for a compound topical medication is additionally limited to a maximum total reimbursement of three hundred dollars ($300.00) for a maximum of one hundred twenty (120) grams per month. A compound topical medication provided in an amount less than one hundred twenty (120) grams per month shall be prorated. Prior authorization (pre-certification) and medical documentation is required for any additional quantity over and above this one hundred twenty (120) grams per month amount.

C.Combined Medications: The entity packaging two or more products together must bill the products as individual line items identified by their original AWP and NDC. This original manufacturer NDC and its associated AWP shall be used to determine ingredient reimbursement. Supplies are considered integral to the package and not separately reimbursed.

D.Other Special Pricing: The maximum allowable reimbursement for manufactured topical medications other than patches is the billed charge up to a maximum of thirty dollars ($30.00) for a thirty (30) day supply, prorated if a lesser amount is provided. Patches will be reimbursed the billed charge up to a maximum of seventy dollars ($70.00) for a thirty (30) day supply, prorated if a lesser amount is provided. Intraarticular Joint Kits are limited to a maximum reimbursement of $27.36.

20 Miss. Code. R. § 2-V

Adopted 6/14/2017

Amended 6/15/2019