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Billing Reminder: Pharmacy 340B Claim Submissions and Dispensing Fees

June 4, 2018

Pharmacy providers are reminded that until such time that the Department of Health Care Services (DHCS) implements the new fee-for-service reimbursement methodology for covered outpatient drugs authorized by SPA 17-002, the pharmacy dispensing fee shall be reimbursed according to the previous methodology ($7.25 retail or $8 in a long term care setting). This includes the dispensing fee submitted for 340B drug claims by covered entities and their contract pharmacies pursuant to Welfare and Institutions Code, Section 14105.46. Once implemented, historical claims adjustments will be made reflecting the new reimbursement methodology, including the new professional dispensing fees (either $10.05 or $13.20) for all claims with dates of service from the effective date of April 1, 2017, through the date of implementation. A new question/answer (#9) reflecting this billing reminder has been added to the Pharmacy Reimbursement Project FAQs on the Pharmacy Reimbursement Project page of the DHCS website.