WSR 23-10-015
HEALTH CARE AUTHORITY
[Filed April 25, 2023, 12:13 p.m.]
NOTICE
Title or Subject: Medicaid State Plan Amendment (SPA) 23-0002 Medicare Part B Drug and Biological Average Sales Price (ASP) Change and Pharmacy Professional Dispensing Fees.
Effective Date: Anticipated on or after April 1, 2023.
Description: On March 21, 2023, under WSR 23-07-114, the health care authority (HCA) filed notice of the intent to submit medicaid SPA 23-0002 to:
•Address changes made by the Centers for Medicare and Medicaid Services (CMS) to the payment methodology for biosimilar drugs in the average sales price (ASP) file. The percentage for these drugs will change from 106 percent to 108 percent. In order to avoid making changes to the medicaid state plan to reflect future percentage changes, HCA is removing the specific percentage amount and replacing it with a reference to the CMS ASP file.
•Address the level of the professional dispensing fees paid to pharmacies for providing services to medicaid clients in the fee-for-service program. In addition to the professional dispensing fees, HCA pays a drug ingredient cost.
That notice stated SPA 23-0002 was expected to increase the annual aggregate expenditures/reimbursement/payments for the payment methodology for biosimilar drugs in the ASP file by an estimated $250,000 annually, combined state and federal funds. It also stated that while SPA 23-0002 was also expected to increase the annual aggregate expenditures/reimbursement/payments in the fee-for-service pharmacy program for professional dispensing fees, HCA did not yet have a formal estimate of the anticipated amount of the potential increase and that HCA did not anticipate changes to the ingredient cost methodology.
At this time, HCA anticipates SPA 23-0002 to increase the annual aggregate expenditures/reimbursement/payments in the fee-for-service pharmacy program for professional dispensing fees. Please note the following amounts are tentative:
Fee Structure
High Volume
Middle Volume
Low Volume
Unit Dose
Increase in fees
$9.80
(Increase of $5.56)
$11.91
(Increase of 7.35)
$14.30
(Increase of $9.05)
$14.30
(Increase of $9.05)
SPA 23-0002 is under development. To request a copy when it becomes available or to submit comments, you may contact Wendy Steffens at wendy.steffens@hca.wa.gov regarding the payment methodology for biosimilar drugs in the ASP file and Donna Sullivan at donna.sullivan@hca.wa.gov regarding professional dispensing fees (please note that all comments are subject to public review and disclosure, as are the names of those who comment).
Contact: See above, HCA, 626 8th Avenue S.E., Olympia, WA 98501, TRS 711.