42 C.F.R. 447.512 - Drugs: Aggregate upper limits of payment
| Cite as | 42 C.F.R. 447.512 |
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19 cases
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State v. Abbott Labs., 2010AP232–AC.
...fee, or 2) the “usual and customary” price the pharmacy charges to consumers paying for the drug without government assistance. 42 C.F.R. § 447.512(b). The regulations define EAC as the “best estimate of the price generally and currently paid by providers for a drug.” 42 C.F.R. § 447.502. W......
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United States ex rel. Schutte v. SuperValu Inc., 20-2241
..."[Actual acquisition cost] plus a professional dispensing fee" or providers’ "usual and customary charges to the general public."1 42 C.F.R. § 447.512(b). Because both Medicare and Medicaid programs involve third-party submission of claims to the government, these reimbursement processes gi......
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United States ex rel. Garbe v. Kmart Corp., 15-1502
...than the prevailing retail market price.” United States v. Bruno's, Inc. , 54 F.Supp.2d 1252, 1257 (M.D. Ala. 1999) (interpreting 42 C.F.R. § 447.512(b), then numbered 42 C.F.R. § 447.331(b) ). Regulations related to “usual and customary” price should be read to ensure that where the pharma......
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United States ex rel. Proctor v. Safeway, Inc., 20-3425
...payments for prescription drugs "must not exceed, in the aggregate," pharmacies' "usual and customary charges to the general public." 42 C.F.R. § 447.512(b). The regulation does not define "to the general public." Id. § 447.512(b)(2). Medicare regulations, by comparison, define U&C as the p......
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5 firm's commentaries
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"Double Dip" Effectively Approved by Center for Medicare and Medicaid Services
...IHS utilization at discounted FSS pricing, and then would receive rebates from manufacturers on those same transactions). See, e.g., 42 C.F.R. § 447.512. Misuse of Schedule These new releases may not sit well with the U.S. Department of Veterans Affairs (VA), the agency that administers the......
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Seventh Circuit Finds that Pharmacy Discount Programs Are Not Exempt from the Definition of “Usual and Customary”
...participating pharmacies to charge Part D members no more than the provider’s “usual and customary charges to the general public.” 42 C.F.R. § 447.512(b)(2). The “usual and customary” price is “the price an out-of-network pharmacy or a physician’s office charges a customer who does not have......
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Seventh Circuit Finds that Pharmacy Discount Programs Are Not Exempt from the Definition of “Usual and Customary”
...participating pharmacies to charge Part D members no more than the provider’s “usual and customary charges to the general public.” 42 C.F.R. § 447.512(b)(2). The “usual and customary” price is “the price an out-of-network pharmacy or a physician’s office charges a customer who does not have......
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Washington Healthcare Update
...key changes that states need to address when determining their reimbursement methodologies, including the revised requirement in 42 CFR §447.512(b) for states to reimburse at an aggregate upper limit based on actual acquisition cost (AAC) plus a professional dispensing fee established by th......
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2 provisions
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P.A. 14-0158, HB 5439 – AN ACT CONCERNING BRAND NAME DRUG PRESCRIPTIONS FOR STATE MEDICAL ASSISTANCE RECIPIENTS
...a generically equivalent drug product for any drug listed in accordance with [the Code of Federal Regulations Title 42 Part 447.332] 42 CFR 447.512 for a drug prescribed for a [Medicaid, or state-administered general] medical assistance recipient unless the [phrase "brand medically necessar......
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Chapter 547, SB 380 – Revises provisions governing the reporting of data concerning the prices of prescription drugs
...and customary price" means the usual and customary charges that a pharmacy charges to the general public for a drug, as described in 42 C.F.R. § 447.512.Sec. 16. NRS 439B.685 is hereby amended to read as follows:439B.685 The Department shall adopt such regulations as it determines to be nec......