To initiate a SMAC price review, complete the MHCP SMAC Research Request Form (DHS-6406) (PDF) and fax it to the Change Healthcare Minnesota SMAC Helpdesk at: 87. Providers may contact Change Healthcare at 85 with questions about the SMAC program or specific SMAC prices. For drugs that do not have a published estimated actual acquisition cost, maximum allowable cost, and specialty pharmaceutical reimbursement rate the maximum payment is the lower of the pharmacy’s usual and customary charge or the Wholesale Acquisition Cost minus 2 percent.Ĭhange Healthcare is the MHCP contracted vendor to maintain the state maximum allowable cost (SMAC) list for generic drugs.
#LOOK UP DRUGS PLUS#
Specialty Pharmaceutical Reimbursement rate (PDF), plus a dispensing fee.The estimated actual acquisition cost of the drug or maximum allowable cost (PDF) for a drug established by DHS, plus a fixed dispensing fee.The pharmacy's usual and customary charge.The maximum payment for any prescribed drug is the lower of the following: If a manufacturer is not listed as a participant in the federal Medicaid Drug Rebate Program, the MHCP program will not cover products from that manufacturer. MHCP requires the 11-digit 5-4-2- format for billing or reporting an NDC. The first segment (5-digits) identifies the manufacturer or labeler of the drug, the second segment (4-digits) identifies the drug and the third segment (2-digits) refers to the package size.
#LOOK UP DRUGS CODE#
The FDA assigns each listed drug product a unique 11-digit, 3-segment number, known as the National Drug Code (NDC). Use the National Drug Code (NDC) search site (or DHS National Drug Code search to determine MHCP coverage of individual drug products. See Provider Requirements section for details. Federal anti-fraud and abuse provisions prohibit certain types of business transactions or arrangements, per Section 231(h) of HIPAA and the Office of Inspector General Special Fraud Alert, 59 Fed. Pharmacies cannot use pharmaceutical manufacturers’ coupons, discounts or similar promotions to attract prescription business from Medical Assistance (MA) members. Providers must contact the appropriate health plan for pharmacy information related to members in managed care organizations (MCO).
Information in this section applies to all of Minnesota's Health Care Programs (MHCP).
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