Oregon Health Authority
Health Systems Division: Medical Assistance Programs - Chapter 410
Division 121
PHARMACEUTICAL SERVICES
410-121-0160
Dispensing Fees
(1) Effective January 1, 2018, professional dispensing fees allowable for services shall be reimbursed as follows:
(a) All enrolled chain affiliated pharmacies with ten or more pharmacies under common ownership shall be reimbursed at a rate of $9.80 per claim. A “chain affiliated pharmacy” shall be defined as a pharmacy that is part of a group of pharmacies under common ownership and does not include fully independent pharmacies or franchise pharmacies;
(b) Independently owned pharmacies in communities that are the only enrolled pharmacy within a fifteen (15) mile radius from another pharmacy shall be reimbursed at a dispensing fee of $14.30 per claim;
(c) All 340B pharmacies operated by a 340B covered entity shall be reimbursed at a rate of $14.30 per claim;
(d) All other enrolled independently owned pharmacies excluding those in 410-121-0160(b) and (c) shall be reimbursed based on an individual pharmacy’s annual claims volume as follows:
(A) Less than 30,000 claims a year = $14.30;
(B) Between 30,000 and 69,999 claims per year = $11.91;
(C) 70,000 or more claims per year = $9.80.
(2) All Division enrolled independent pharmacies shall be required to complete an annual survey that collects claim volumes from enrolled pharmacies and other information from the previous 12-month period to determine the appropriate dispensing fee reimbursement:
(a) Claims volume shall be stated by total OHP covered prescriptions and claims from all payer types;
(b) Survey activities shall be conducted by either the Division or its contractor and must be completed and returned by pharmacies within 14 days of receipt;
(c) Completed surveys must be signed with a letter of attestation by the store owner or majority owner;
(d) Pharmacies that fail to respond to the survey or do not include the letter of attestation shall default to the lowest dispensing tier;
(e) Once a tier is established for a calendar year, the pharmacy’s dispensing fee shall remain in that tier until the next annual claims volume survey is conducted;
(f) Newly enrolled 340B pharmacies shall be reimbursed at a rate of $14.30 per claim. All other independent pharmacies shall be defaulted to the lowest dispensing tier until the next claims volume survey is conducted.
(3) All chain affiliated pharmacies shall be exempt from completing the annual claims volume survey.
[Publications referenced are available from the agency.]
Statutory/Other Authority: ORS 413.042 & 414.065
Statutes/Other Implemented: ORS 414.065
History:
DMAP 50-2017, amend filed 12/05/2017, effective 01/01/2018
DMAP 44-2011, f. 12-21-11, cert. ef. 1-1-12
DMAP 22-2011(Temp), f. 7-29-11, cert. ef. 8-1-11 thru 1-25-12
DMAP 14-2011, f. 6-29-11, cert. ef. 7-1-11
DMAP 40-2010, f. 12-28-10, cert. ef. 1-1-11
DMAP 26-2007, f. 12-11-07, cert. ef. 1-1-08
OMAP 16-2006, f. 6-12-06, cert. ef. 7-1-06
OMAP 19-2005, f. 3-21-05, cert. ef. 4-1-05
OMAP 21-2004, f. 3-15-04, cert. ef. 4-15-04
OMAP 19-2004(Temp), f. & cert. ef. 3-15-04 thru 4-14-04
OMAP 7-2004, f. 2-13-04, cert. ef. 3-15-04
OMAP 57-2003, f. 9-5-03, cert. ef. 10-1-03
OMAP 32-2003(Temp), f. & cert. ef. 4-15-03 thru 9-15-03
OMAP 60-2001, f. & cert. ef. 12-11-01
OMAP 50-2001(Temp), f. 9-28-01, cert. ef. 10-1-01 thru 3-1-02
OMAP 1-1999, f. & cert. ef. 2-1-99
OMAP 22-1998, f. & cert. ef. 7-15-98
OMAP 5-1998(Temp), f. & cert. ef. 2-11-98 thru 7-15-98
HR 12-1994, f. 2-25-94, cert. ef. 2-27-94
HR 21-1993(Temp), f. & cert. ef. 9-1-93
HR 29-1990, f. 8-31-90, cert. ef. 9-1-90
HR 20-1990, f. & cert. ef. 7-9-90, Renumbered from 461-016-0260
AFS 79-1989, f. & cert. ef. 12-21-89
AFS 63-1989(Temp), f. & cert. ef. 10-17-89
AFS 56-1989, f. 9-28-89, cert. ef. 10-1-89, Renumbered from 461-016-0101
AFS 64-1988, f. 10-3-88, cert. ef. 12-1-88
AFS 41-1988(Temp), f. 6-13-88, cert. ef. 7-1-88
AFS 50-1987, f. 10-20-87, cert. ef. 11-1-87
AFS 28-1987(Temp), f. & cert. ef. 7-14-87
AFS 12-1987, f. 3-3-87, cert. ef. 4-1-87
AFS 52-1986, f. & cert. ef. 7-2-86
AFS 36-1986, f. 4-15-86, cert. ef. 6-1-86
AFS 13-1986(Temp), f. 2-5-86, cert. ef. 3-1-86
AFS 66-1985, f. 11-5-85, cert. ef. 12-1-85
AFS 54-1985(Temp), f. 9-23-85, cert. ef. 10-1-85
AFS 1-1985, f. & cert. ef. 1-3-85
AFS 41-1984(Temp), f. 9-24-84, cert. ef. 10-1-84
AFS 56-1983, f. 11-17-83, cert. ef. 12-1-83
AFS 51-1983(Temp), f. 9-30-83, cert. ef. 10-1-83