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Alabama Medicaid Agency. State MAC Program May 28, 2008. Alabama Medicaid Agency. Welcome and Introductions. Alabama Medicaid Agency. ALMA Goals and Objectives for Pharmacy Reimbursement Better alignment of reimbursement to actual cost Budget neutral impact to pharmacies and state budget.

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Presentation Transcript
alabama medicaid agency

Alabama Medicaid Agency

State MAC Program

May 28, 2008

alabama medicaid agency1
Alabama Medicaid Agency
  • Welcome and Introductions
alabama medicaid agency2
Alabama Medicaid Agency
  • ALMA Goals and Objectives for Pharmacy
  • Reimbursement
    • Better alignment of reimbursement to actual cost
    • Budget neutral impact to pharmacies and state budget
alabama medicaid agency3
Alabama Medicaid Agency
  • Initiatives to meet goals and objectives
    • Cost of dispensing survey
    • State MAC rates based on average actual acquisition cost
    • Data gathered from Alabama Medicaid participating pharmacies
    • Future “Pharmacy First” concept
alabama medicaid agency4
Alabama Medicaid Agency
  • Introduction of Myers and Stauffer
    • Company background
    • Pharmacy and State MAC program services
alabama medicaid agency5
Alabama Medicaid Agency
  • State MAC Program Overview
    • Regularly survey Alabama Medicaid participating pharmacies
    • Compile, scrub and review acquisition cost data
    • Determine average acquisition cost
    • Apply a factor (multiplier) to average acquisition costs
    • Post State MAC rates
    • Address MAC rate concerns
alabama medicaid agency6
Alabama Medicaid Agency
  • Survey Process
    • Survey letter requesting recent

purchase history (A/P invoices)

    • Data submission by pharmacies
      • Copy and mail, or
      • Email electronic file(s)
alabama medicaid agency7
Alabama Medicaid Agency
  • Survey Process (cont.)
    • Mandatory participation

(no more often than once every two years)

    • Frequency of surveys

(quarterly, semi-annual or annual)

    • Representative sample of pharmacies
alabama medicaid agency8
Alabama Medicaid Agency

Sample State MAC Rate Calculation

alabama medicaid agency9
Alabama Medicaid Agency
  • Help Desk Contacts
    • Toll-free phone: (800) 591-1183
    • Email: pharmacy@mslc.com
    • Fax: (317) 571-8481
    • Web portal
alabama medicaid agency10
Alabama Medicaid Agency
  • State MAC website
  • http://al.mslc.com
alabama medicaid agency11
Alabama Medicaid Agency
  • ALMA Plan for Pharmacy Reimbursement
    • Better align reimbursement for ingredient and dispensing costs
    • Budget neutral – any savings will be used to reimburse pharmacists for cognitive services
alabama medicaid agency12
Alabama Medicaid Agency
  • Discussion and Questions