Can a covered entity bill a Medi-Cal Managed Care Plan at a rate higher than the acquisition cost plus a fee?
A covered entity using a 340B program contract pharmacy may arrange with the contract pharmacy to dispense 340B program drugs to Medi-Cal managed care recipients and bill for such 340B program drugs at the contract rate negotiated with the plan (excluding drugs dispensed to members of rebate-eligible COHS plans). Please review following FAQ #9 for detailed information.
Related Questions
- If an SAE occurs for an enrollee in a Medicaid managed care plan, how will the GME billing (rate code 3130) to DOH be handled?
- Are the covered benefits the same for Medi-Cal Beneficiaries versus Health Plan of San Joaquin Medi-Cal Members?
- What is the rate of reimbursement for covered services under the POS CIGNA Plan?
