- There is no visibility into how to manage the medical cost. For Medicaid plans the medical benefit is difficult to manage because drug spend and utilization is much more complicated. The pricing information found on ReimbursementCodes can help manage drug spend as the standard rate for which Medicaid programs reimburse their claims – especially for high cost drugs that have limited utilization.
- There is a need to have an accurate HCPCS/CPT® to NDC Crosswalk. Almost all Medicaid plans require NDC units of measure on claims. Medical benefit drugs typically use HCPCS/CPT® codes for reimbursement on claims, not necessarily NDC. ReimbursementCodes has an accurate crosswalk as well as a conversion tool for HCPCS/CPT® to NDC level units so manufacturer rebates can be captured. No other tool on the market converts HCPSC/CPT® drug code units to NDC units at both utilization and pricing levels.
The 39th Annual Eastern Medicaid Pharmacy Administrators (EMPAA) Conference was held this past week in Stowe, Vermont, at the beautiful Stowe Mountain Lodge in the foothills of the Green Mountains. EMPAA is a non-profit association of representative members from State Medicaid Pharmacy programs in the Northeast. The organization holds an annual meeting to share and communicate ideas to improve their understanding of current Medicaid issues and discuss possible solutions. RJ Health Systems was in attendance last week, which provided an opportunity for us to network with Medicaid plans. We discussed how Medicaid plans are addressing the impact that costly increases are having on their budgets. Many in attendance suggested changing Prior Authorization and Clinical programs for Pharmacy because they had visibility into how Pharmacy is being managed. When it came to Medical, most Medicaid plans do not have that same visibility. The discussion was focused on Pharmacy benefit, but two main issues arose when talking about Medical benefit: