Changes to the Reimbursement Methodology for 340B Long-Acting Reversible Contraception (LARC)

In accordance with the Pharmacy Clinical Policy, Physician Administered Drug Program (PADP), NC Medicaid will implement changes to the reimbursement methodology for 340B Long-Acting Reversible Contraception (LARC) on March 12, 2023. These changes were approved by the Centers for Medicare & Medicaid Services (CMS) on Jan. 25, 2023, with a retroactive effective date of Dec. 1, 2022.

This new reimbursement methodology for LARCs acquired and dispensed under the 340B program will include the following:    

• Require 340B LARCs to be priced at ceiling price plus 6%
• Require 340B LARCs to be reimbursed on the lesser of 106% 340B ceiling price or 106% of billed amount.