Skip to main content

Table 7 Medicaid Pharmaceutical Reimbursement Structure in Maine and Washington, Quarter Ending March 2006

From: Drug utilization and cost in a Medicaid population: A simulation study of community vs. mail order pharmacy

  Maine Washington
Drug Product Cost Community
General: AWP-15%
Direct supply drug list:*
Usual & customary charge or AWP-17% plus $3.35 professional fee or FUL or MAC plus $3.35 professional fee
Mail order
Lowest of: usual & customary charge, AWP-20% plus $1.00 professional fee, or FUL or MAC plus $1.00 professional fee
Community
AWP-14% single source & multiple source (w/2–4 manufacturers) AWP-50% multiple source from 5+ manufactures
Mail order
AWP-19% (brand-mail order), AWP-15% (generic-mail order)
Dispensing Fee Community and Mail Order
$3.35; $4.35 5.35(compounding);$12.50 (insulin syringe)
Community
$4.20–$5.20
Mail order
$3.25
Co-Payment Community
$2.50 generic & brand, not to exceed
$25/mo.
Mail order
None
Community and Mail Order
None
  1. *Note: AWP = average wholesaler price; FUL = Federal Upper Limit; MAC= maximum allowable cost. Direct Supply Drug List: list of covered drugs consisting of certain maintenance drugs including specialty drugs, caloric supplements and substitutes and medical foods. Source: Centers for Medicare and Medicaid Services, 2006.
  2. (Centers for Medicare & Medicaid Services 2006)