For the first time, a regional effort is underway to analyze the cost of dispensing prescriptions to Medicaid beneficiaries. The New England States Consortium Systems Organization (NESCSO), a nonprofit organized by the health and human service agencies of the New England states and UMass Medical School, has partnered with the accounting firm of Myers and Stauffer LC to survey pharmacies in the region.
State Medicaid agencies are being directed by the federal Centers for Medicare and Medicaid Services (CMS) to review the way they pay pharmacies for dispensing medications. New rules released in January require states to adopt fee-for-service pharmacy payment policies designed to pay pharmacies for the cost of acquiring the drugs as well as an additional professional dispensing fee. The results of this New England survey will help each state’s Medicaid program determine an appropriate professional dispensing fee.
Surveys are being distributed to Medicaid-enrolled pharmacies across New England in early September. Pharmacies will have approximately four weeks to complete the survey and return it to Myers and Stauffer. Independent pharmacies will receive surveys in the mail and most chain pharmacies will coordinate survey distribution through corporate or regional offices. Pharmacies will be able to learn more about the surveys by signing up for telephone and webinar presentations.
Submitted surveys will be reviewed and analyzed by Myers and Stauffer. A report and presentation of the survey results will be shared with NESCSO and participating state Medicaid programs.
NESCSO is managing and contracting this regional project through its relationship with UMass Medical School’s Commonwealth Medicine division on behalf of the departments of health and human services within New England. NESCSO is a nonprofit corporation organized by the New England state health and human service (HHS) agencies and UMass Medical School. NESCSO’s board is composed of the member states’ HHS secretaries or their designees. NESCSO’s mission is to foster communication and collaboration among its members through information sharing and joint projects. NESCSO seeks to support the needs of the state HHS Secretaries by providing a framework for knowledge exchange in order to maximize policy, program and cost-effectiveness. Annually, NESCSO convenes the Medicaid Enterprise Systems Conference and markets “MAGI in the cloud” for states to use in determining income eligibility under the Affordable Care Act.
Myers and Stauffer LC is a Certified Public Accounting firm with 18 offices nationwide and over 700 employees. The firm is strongly focused on assisting government health care agencies with audit, rate-setting, program integrity, consulting and other support services. Since the late 1970s, Myers and Stauffer has performed over 100 Medicaid pharmacy cost of dispensing surveys in more than 20 states. The firm is also a leader in assisting state Medicaid programs with pharmacy reimbursement based on actual acquisition cost. In addition to working with state Medicaid programs directly on actual acquisition cost reimbursement, Myers and Stauffer has been the contractor to CMS since 2011 to develop and maintain the National Average Drug Acquisition Cost (NADAC) benchmark.