N.J. Admin. Code § 10:51-1.7

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:51-1.7 - Prescription dispensing fee

(a) The dispensing fee for legend drugs, dispensed by providers having retail permits to beneficiaries other than those in long-term care facilities, including State-operated Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID), nursing facilities, and State- and county-operated long-term psychiatric hospitals, is $ 3.73. Additional dispensing fees (add-ons) per prescription shall be given to pharmacy providers who provide the following:

1. Twenty-Four Hour Emergency Service: $ 0.11. The provider shall have a 24-hour per day, 365-days-per-year prescription service available and shall have provided Medicaid or NJ FamilyCare beneficiaries opportunities to utilize this service.

2. Patient Consultation: $ 0.08. In addition to routinely monitoring beneficiary profiles for drug interactions, contraindications, allergies, etc., the provider shall, where appropriate, discuss the course of drug therapy with the beneficiary. This discussion must include emphasis on compliance with the prescriber's orders; proper drug utilization; cautions about possible side effects; foods to avoid; proper drug storage conditions; and any other information that will prove beneficial to the beneficiary while on drug therapy.

3. Impact Area Location: $ 0.15. The provider shall have a combined Medicaid/NJ FamilyCare, and Pharmaceutical Assistance to the Aged/Disabled (PAAD) prescription volume equal to or greater than 50 percent of the provider's total prescription volume.

i. The nursing facility prescription volume shall be included for the determination of total prescription volume in determining entitlement to the impact allowance.

(b) Providers of pharmaceutical services in assisted living residences (ALRs) and comprehensive personal care homes (CPCHs) shall be reimbursed a dispensing fee per prescription dispensed to residents of these facilities in accordance with (a) above.

(c) Price information is supplied from a reference drug file subcontracted for this purpose by the fiscal agent and accepted by the Division as the primary source of pricing information for the New Jersey Medicaid Management Information System (NJMMIS). The calculated price shall not exceed the lower of the average wholesale price (AWP) or the Federal Fund Participation Upper Limit (FFPUL) as supplied by the reference drug file contractor.

(d) In order to receive any or all of the above increments, the provider shall certify annually to the Division on Form FD-70, that the service(s) as defined in (a) above, are being provided and/or that the provider is entitled to the impact increment as defined in (a) above.

1. Each claimed increment is subject to audit and retroactive recovery with appropriate penalties, if warranted, if the Division determines that the provider was not entitled to reimbursement for them.

(e) Failure to submit this report annually shall result in retail pharmacy provider payments based on the basic dispensing fee of $ 3.73.

N.J. Admin. Code § 10:51-1.7

Amended by 48 N.J.R. 2785(a), effective 12/19/2016