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

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

	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

*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.
(Centers for Medicare & Medicaid Services 2006)

ISSN: 1472-6963