Entry is through security at the main entrance of the building facing North Lamar Boulevard.

Hearing. Health and Human Services Commission (HHSC) will conduct a public hearing on Monday, November 23, 2015, at 8:45 a.m. to receive comment on proposed Medicaid fee-for-service (FFS) payment rates for pharmaceutical providers.

The public hearing will be held in the HHSC Public Hearing Room at the Brown-Heatly Building, located at 4900 North Lamar Boulevard, Austin, Texas 78751. Entry is through security at the main entrance of the building, which faces the North Lamar Boulevard. The hearing will be held in compliance with §32.0282 of the Texas Human Resources Code, and §355.201 of Title 1 Texas Administrative Code (TAC) which require a public hearing and notice for adjustments of Medicaid fees, rates, and charges.

Proposal. HHSC is proposing a new FFS pharmacy reimbursement methodology with ingredient costs that differ by pharmacy type, and a dispensing fee formula that includes a variable component. The new methodology will utilize either the National Average Drug Acquisition Cost (NADAC)—the new benchmark of retail pharmacy acquisition costs developed by the Centers for Medicare & Medicaid Services,—or the Wholesale Acquisition Cost (WAC) when no NADAC pricing is available. Under the new methodology, some ingredient costs are increasing while others are decreasing; yet, in the aggregate, the new methodology will lower ingredient costs. On the other hand, the new dispensing fee methodology will increase the dispensing fee reimbursement. The new payment rates for FFS pharmaceutical providers are proposed to be effective March 1, 2016.

Methodology and Justification. HHSC is concurrently amending rules in the TAC to implement the new proposed methodology. The rule amendments are proposed to effective March 1, 2016. The proposed payment rates were calculated in accordance with the following sections of Title 1 of the TAC:

• Proposed §355.8541, which addresses the drug ingredient cost reimbursement methodology for pharmaceutical providers; and
• Proposed §355.8551, which addresses the drug dispensing fee reimbursement methodology for pharmaceutical providers.

Briefing Package. Since there are thousands of National Drug Codes (NDCs), and both NADAC and the WAC are frequently changing, including specific rates under the new methodology in this notice is not appropriate. Yet, a package describing the proposed payment methodology is available online. Those interested may obtain a copy of the briefing package before the hearing by contacting the Vendor Drug Program at 512-707-6148 or at Stacey.Johnston@hhsc.state.tx.us. The briefing package will also be available at the public hearing.

Written Comments. Written comments may be sent by U.S. mail, overnight mail, special delivery mail, hand delivery, fax, or email:

U.S. Mail
Texas Health and Human Services Commission
Attention: Stacey Johnston, Vendor Drug Program
Mail Code 2250
P.O. Box 85200
Austin, Texas 78708-5200

Overnight mail, special delivery mail, or hand delivery
Texas Health and Human Services Commission
Attention: Stacey Johnston, Vendor Drug Program
Mail Code 2250
Brown-Heatly Building
4900 North Lamar
Austin, Texas 78751
Phone number for package delivery: 512-707-6148
Fax: 512730-7483 Attention:  Stacey Johnston
Email: Stacey.Johnston@hhsc.state.tx.us