The State of Wisconsin reimburses pharmacies for services provided to low-income persons under the authority of Title XIX of the Federal Social Security Act and sections 49.43 to 49.47, Wisconsin Statutes. The Wisconsin Department of Health Services (DHS) administers this program, which is called Medical Assistance or Medicaid. In addition, the state of Wisconsin reimburses pharmacies for services provided under the authority of chapters 49.471, 49.665, and 49.688, Wisconsin Statutes.

Under the Wisconsin State Medicaid Plan as approved by the U.S. Department of Health and Human Services, DHS establishes maximum allowable fees for all covered pharmaceutical items provided to Wisconsin Medicaid recipients. The Plan further specifies that DHS will provide public notice in advance of the effective date of any significant change in maximum allowable fees. Federal regulations at 42 CFR §§ 447.512 – 447.518 establish certain aggregate upper limits in State Medicaid expenditures for drugs. This notice is to announce new rates for specialty pharmacy drugs.

Specialty pharmacy drugs are defined as typically high cost drugs, used to treat acute and chronic conditions. They often require special handling, and can be self-administered in the home or administered by a health care provider. Specialty drugs are often associated with complex drug regimes and require patient education, monitoring and clinical support. The Department uses marketplace research or best estimate of prices currently and generally paid for those drugs to establish the new rates.

Effective for dates of service on and after April 15, 2010, DHS is proposing to establish new rates for specialty pharmacy drugs in accordance with the approved Wisconsin Medicaid State Plan. The rates for specialty pharmacy drugs are published by DHS and are available in the data table section of the Pharmacy page, located in the Provider area of the ForwardHealth Portal at www.forwardhealth.wi.gov.

This proposal is estimated to reduce Wisconsin Medicaid expenditures by $2.9 million, all funds, in state fiscal year (SFY) 2010. This amount is divided between federal and state shares. The federal share is different in every state, and in every state it differs somewhat year to year, with Wisconsin's rate generally being approximately around 60% federal/40% state. In addition, the American Recovery and Reinvestment Act of 2009 (ARRA), increases the federal share for Medicaid expenditures during the recession adjustment period, as defined in that law. Using the 60/40 proportion, this savings would be composed of $1.74 million FED and $1.16 million GPR.

A copy of the proposed change is available for review at the main office of any county department of social services or human services.

A copy of the proposed changes may also be obtained free of charge by calling or writing as follows:

Regular Mail

James Vavra

Division of Health Care Access and Accountability

P.O. Box 309

Madison, WI 53701-0309

Phone

James Vavra

(608) 261-7838

FAX

(608) 266-1096

Attention: James Vavra

E-Mail

james.vavra@dhs.wisconsin.gov

Written comments are welcome. Written comments on the changes may be sent by FAX, e-mail, or regular mail to the Division of Health Care Access and Accountability. The FAX number is (608) 266-1096. The e-mail address is james.vavra@dhs.wisconsin.gov. Regular mail can be sent to the above address.

The written comments will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 350 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin.