---NOTE: THIS ALERT IS A
REMINDER OF THE ALERT DATED October 26, 2006---
TO: All Pharmacy Providers
As a
reminder, the below paragraph was an ALERT disseminated to all pharmacy
providers on 10/26/2006, and has been posted on the Agency website since that
date. This policy continues to be in effect. Per Alabama Medicaid
Administrative Code, Rule No. 560-X-16-.06 “Reimbursement for Covered Drugs and
Services,” Usual and Customary is defined as the “charge to the general public
regardless of program fees."
In response to pharmacy retailers’ recent announcements of reduced
prices for specific generic drugs, the Alabama Medicaid Agency will consider
these reduced prices to be the “usual and customary” price for these retailers.
Retrospective audits identifying claims that are inappropriately charging
Alabama Medicaid any amount over the usual and customary amount will be
recouped. Please refer to our Administrative Code Rule No. 560-X-16-.06,
“Reimbursement for Covered Drugs,” as well as Provider Billing Manual Chapter
27, for more information on our reimbursement policy.
For additional questions
regarding this ALERT, please contact Pharmacy Services at (334) 242-5050.
The Current
Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes
descriptors, and other data are copyright © 2019 American Medical Association and
© 2019 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.