Covered Outpatient Drug Pricing

ForwardHealth implemented changes to its billing and reimbursement policies for covered outpatient drugs, effective for dates of service on and after April 1, 2017, in accordance with the Centers for Medicare and Medicaid Services (CMS federal Covered Outpatient Drugs Final Rule (CMS-2345-FC). The intent of the federal regulation was to address the rise in prescription drug costs by ensuring that Medicaid programs reform payment methodologies for prescription drugs and drug rebates to accurately reflect market prices.

ForwardHealth published the March 2017 ForwardHealth Update (2017-07), titled "Changes to Billing and Reimbursement Policy for Covered Outpatient Drugs," with the billing and drug reimbursement policies effective April 1, 2017.

Contact Information

Below is a list of resources for questions about ForwardHealth's covered outpatient drug billing and reimbursement policy changes.

• Provider Services Call Center — 800–947–9627
• Member Services Call Center — 800–362–3002

Frequently Asked Questions About ForwardHealth's Covered Outpatient Drug Pricing Initiative

ForwardHealth has developed Frequently Asked Questions (FAQs) About ForwardHealth’s Covered Outpatient Drug Pricing Initiative, February 10, 2017.

Resources

• Professional Dispensing Fee Survey
• Prescription Volume Attestation Survey
• ForwardHealth Covered Outpatient Drug Reimbursement presentation, January 19, 2017
• ForwardHealth Covered Outpatient Drug Reimbursement handout, January 19, 2017
• Federal Register to the Covered Outpatient Drug Final Rule
• Medicaid.gov Covered Outpatient Drugs Policy
• Register for the Outpatient Drug Rule Email Subscription
• ForwardHealth Email Subscription User Guide
• ForwardHealth Covered Outpatient Drug Reimbursement Stakeholder Meeting, May 10, 2016
• ForwardHealth Pharmacy Reimbursement presentation, April 5, 2016