Texas Health and Human Services Commission (HHSC) has finally issued final regulations transitioning to the use of the National Average Drug Acquisition Cost (NADAC) to establish Medicaid ingredient cost reimbursement instead of utilizing manufacturer-reported prices. As such, effective May 16, 2016, pharmaceutical manufacturers will not be required to provide monthly calculations of Average Wholesale Price, Price to Wholesaler/Distributor, Direct Price to Pharmacy, Direct Price to Chain Pharmacy and Direct Price to Long Term Care Pharmacy to HHSC beginning in June 2016.
Manufacturers that add a product to the Texas Drug Code Index will still be required to submit a Certificate of Information for the Addition of a Drug Product. That certificate includes Average Manufacturer Price, Average Wholesale Price, Direct Price to Long Term Care Pharmacy, Direct Price to Pharmacy and Price to Wholesaler/Distributor. In addition, manufacturers will still be required to submit price updates as requested by HHSC and will have ten days to submit price changes once the HHSC requests that information.
For more information see 41 TexReg 3298-3299, which includes published Amendments to the Texas Administrative Code Chapters 354 and 355, including § 354.1921. These amendments were adopted without changes to the proposed rules that were released October 30, 2015 (40 TexReg 7507), and will go into effect May 15, 2016.