What will plan sponsors typically offer pharmacies for prescription drug reimbursements and dispensing fees?
• A: CMS will not dictate what plan sponsors should be offering pharmacies in terms of reimbursements and dispensing fees. However in section §423.100 of the final rule, CMS determined that the dispensing fee will include only those activities related to the transfer of possession of the covered Part D drug from the pharmacy to the beneficiary, including charges associated with mixing drugs, delivery, and overhead. The dispensing fee will not include any activities beyond the point of sale (that is, pharmacy follow-up phone calls) or any activities for entities other than the pharmacy. Therefore, activities related to drug utilization review (DUR) and medication therapy management services (MTMS), if covered by a plan, would not be included in the dispensing fee but rather billed separately.
