Special Notice

This notice was published in the March 15, 2016, issue (Vol. 2016, No. 6) of the Utah State Bulletin.

Special Notice: Pharmacy Services

The Division of Medicaid and Health Financing (DMHF) will submit changes to the Medicaid State Plan to implement the new Federal Upper Limits published by the Centers for Medicare and Medicaid Services (CMS).

SPA 16-0010-UT Federal Upper Limit, therefore, amends the pricing for medications that have a Federal Upper Limit established by CMS.

The reimbursement for drugs will be amended to reimburse the lesser of the Utah Estimated Acquisition Cost, Utah Maximum Allowable Cost, Federal Upper Limit, or the Submitted Cost.

DMHF does not expect an impact to total annual expenditures due to these changes.

These proposed changes, if approved, become effective on May 1, 2016.

These proposed changes are pending CMS approval.

A copy of the changes may be obtained from Craig Devashrayee (801-538-6641), or by writing the Technical Writing Unit, Utah Department of Health, PO Box 143102, Salt Lake City, UT 84114-3102. Comments are welcome at the same address. Copies of the changes are also available at local county health department offices.

Additional Information

The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull-pdf/2016/b20160315.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.

For questions regarding this notice, please contact Craig Devashrayee, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov.