D.C. Mun. Regs. tit. 29, r. 29-2709

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-2709 - METHODS FOR DETERMINING COST FOR SINGLE SOURCE DRUGS

2709.1

Reimbursement for brand name drugs shall include a professional dispensing fee in the amount of $11.15 and the lesser of:

(a) The pharmacies' usual and customary charges to the general public ; or

(b) The Actual Acquisition C ost (AAC), which shall be determined by DHCF in accordance with § 2709.2.

2709.2

The AAC shall be determined by DHCF based upon the lesser of:

(a) The NADAC when available, which shall be published online at https://www.medicaid.gov/medicaid/prescription-drugs/pharmacypricing/index.html [File Link Not Available]; or

(b) The WAC plus zero percent (0%), which shall be kept by drug file pricing compendia vendors or drug databases approved by and in use at the federal level.

D.C. Mun. Regs. tit. 29, r. 29-2709

Notice of Final Rulemaking published at 59 DCR 2298, 2306 (March 23, 2012); amended by Final Rulemaking published at 65 DCR 7824 (7/27/2018)

Authority: The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code § 1-307.02 (2006 Repl. & 2011 Supp.)) and section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2008 Repl.)).