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How does DMAP reimburse pharmacies for drugs dispensed to residents in long-term care facilities?

April 26, 2017dispensed dmap drugs facilities long-term pharmacies reimburse residents

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How does DMAP reimburse pharmacies for drugs dispensed to residents in long-term care facilities?

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A. If an OHP client is in a long-term care facility or community-based waiver facility and served by a qualified pharmacy, the dispensing fee is $3.91 and reimbursement is the lower of U/C, SMAC, FUL or AWP-11%. Certain drugs are part of the facility capitation payments and not reimbursed via drug claim. See NH List (at the bottom of the Web page under the Miscellaneous heading).