Annual Prescription Volume Attestation Resources

The purpose of this Annual Prescription Volume Attestation Resources page is to provide you with explanations, clarifications, and resources. The prescription volume attestation survey is now available until January 31, 2023.

Who attests?

Providers who submit claims to ForwardHealth with National Drug Codes are required to attest (that is, to affirm, show, or state something to be true) to their annual prescription volume. This requirement does not apply to tribal federally qualified health centers, community health centers, and out-of-state providers.

How to attest?

Complete the annual prescription volume attestation survey that has been made available to providers on behalf of the Wisconsin Department of Health Services by Mercer, a health care consulting firm, by January 31, 2023. Providers are required to complete the survey for all prescriptions dispensed, not just Medicaid prescriptions.

Organizations with multiple locations will be required to attest for each location individually.

Providers may submit surveys using a web-based tool or a Microsoft Excel format. The Microsoft Excel format allows providers to submit a single survey document for multiple locations; the web-based tool does not.

Survey Instructions

The Prescription Volume Attestation Survey Instructions provide guidance about completing the web-based survey and the Microsoft Excel survey.

Web-Based Survey

Providers may access the online survey in one of three ways: by using the unique individual survey link sent by Mercer email, by scanning the QR code on the 2023 annual prescription volume survey cover letter dated January 9, 2023, or by using the general web-based survey link.

Microsoft Excel Survey

Providers may download and complete the Microsoft Excel survey. Completed Microsoft Excel surveys should be emailed to CODSurvey@mercer.com or faxed to 212-948-0047 to the attention of Kerri Wade.

What happens next?

Information from the 2023 attestation survey will be used to assign the appropriate professional dispensing fee reimbursement rate based on the annual prescription volume for each provider. Providers will be notified of their rate assignments in March 2023. The new professional dispensing fee reimbursement rate assignments will be effective for dates of service (DOS) on and after April 1, 2023.

If a provider does not submit a survey by January 31, 2023, ForwardHealth will assign that provider the lowest professional dispensing fee reimbursement rate.

Professional dispensing fee reimbursement rates for DOS before April 1, 2023, will not be impacted by the 2023 prescription volume attestation survey.

Why is this necessary?

The Centers for Medicare & Medicaid Services published the federal Covered Outpatient Drugs Final Rule (CMS-2345-FC) in January 2016 to address the rise in prescription drug costs by ensuring that Medicaid programs reformed payment methodologies for prescription drugs and drug rebates to accurately reflect market prices.

In accordance with the federal rule, ForwardHealth revised its pharmacy reimbursement policy, including implementing a professional dispensing fee reimbursement rate structure based on a provider’s annual prescription volume, effective for DOS on and after April 1, 2017.

Resources

• FAQs
  • FAQs: ForwardHealth's Covered Outpatient Drug Pricing Policy and Prescription Volume Attestation, December 19, 2022
  • FAQs: Prescription Volume Attestation Survey, January 9, 2023
• Letters
  • 2023 Annual Prescription Volume Pre-Attestation Survey Letter, December 19, 2022
  • 2023 Annual Prescription Volume Attestation Survey Cover Letter, January 9, 2023
• Covered outpatient drug pricing policy, Pharmacy service area of the ForwardHealth Online Handbook
• Mercer attestation survey help
  • Email: CODSurvey@mercer.com
  • Survey hotline: 844-294-9982 (available Monday through Friday between 9 a.m. and 5 p.m. Central time)