NADAC Pricing for Medicaid Pharmacy claims

​NADAC Pricing for Medicaid Pharmacy Claims

 

 

 

 

The National Average Drug Acquisition Cost (NADAC) is based on the retail price survey and focuses on the retail community pharmacy acquisition costs.  CMS has mandated that Medicaid pharmacy programs reimburse the actual acquisition cost (AAC) of drugs plus a professional dispensing fee.  The NADAC represents the average acquisition cost.  The pharmacies surveyed include independent retail and community pharmacies and chain pharmacies.  The prices are updated and loaded into the WV Medicaid Pharmacy Point of Sale (POS) claims system, operated by Molina Medicaid Solutions, on a weekly basis.   (If you find that you are being reimbursed less than your actual acquisition cost when paid with a NADAC price, please check the NADAC file or re-bill your claim to see if the price has been updated.)  BMS has found that some prices are updated and given a retroactive date.

 

To view the NADAC weekly files and the NADAC Week to Week File Comparison, please visit the Pharmacy Drug Pricing Page on the CMS website at https://www.medicaid.gov/medicaid/prescription-drugs/pharmacy-pricing/index.html.

 

Please note that the NADAC file is updated on a weekly basis. Each month, a new file is posted to reflect findings from the previous month’s survey results incorporating the weekly price changes that have occurred in the interim weeks before the next monthly NADAC file.  In addition, to easily identify and understand the pricing changes that occur each week, a NADAC Week to Week File Comparison will accompany the weekly NADAC file. This comparison file identifies the drug products with current NADAC rates that are replaced with new NADAC rates. Other changes (e.g. NDC additions and terminations) to the NADAC file are not reflected in this comparison. 

 

 

 

 Please contact the NADAC Help Desk for support of the NADAC survey, or to provide notification of recent drug price changes that are not reflected in posted NADAC files.

 

Facsimile: (844) 860-0236

 

Help Desk Form at https://www.medicaid.gov/medicaid/prescription-drugs/downloads/retail-price-survey/hdform.pdf

Please complete this form on the website to address specific complaints about reimbursement and request a review of NADAC pricing.  An invoice for the drug requiring review will be requested.