Changes to Pricing Methodology for 340B Pharmacy Claims

Effective Jan. 28, 2024, the pricing methodology for non-blood clotting factor, 340B pharmacy claims will be updated to the lesser of the 340B acquisition cost or the 340B Ceiling price on file.

If the submitted 340B acquisition cost is higher than the 340B Ceiling price the following message will be displayed on the National Council for Prescription Drug Programs (NCPDP) response transaction: "Submitted 340B acquisition cost was higher than expected. Reimbursement will be calculated based on the 340B Ceiling Rate on file.”

This change will not affect claims with dates of service before Jan. 28, 2024.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24003-R-2719