Usual & Customary Amount on Electronic Drug Claims


To: All Pharmacy Providers, Pharmacy Associations, and Vendors

Effective April 13, 2010, Alabama Medicaid will accept the Usual & Customary (U & C = charge to the general public) amount in Field 426-DQ on Electronic Drug claims. Currently, the Agency requires the total amount due on a drug claim in the "Gross Amount Due" Field 430-DU while the U & C amount in Field 426-DQ is not captured.

Effective April 13, 2010, the Agency will accept the U & C amount in Field 426-DQ in the "lower of" reimbursement methodology. Pharmacies should submit their U & C amounts in Field 426-DQ, and must continue to submit the ‘Total Amount Due’ in the Gross Amount Due field. The Alabama Medicaid Companion Guide to the NCPDP 5.1 Specifications has been updated on the Medicaid website ( to reflect this change. Questions related to electronic billing should be directed to HP at 1-800-456-1242 in state, and 1-334-215-0111 out of state.