Description of Managed Care Plan Requirement. Effective January 1, 2020, ODM implemented a supplemental dispensing fee for retail pharmacies. The MCPs are required to pay a supplemental per script dispensing fee to retail pharmacies serving MMC enrollees.
Description of Managed Care Plan Requirement. ODM requires that MCPs provide enhanced reimbursement to hospitals for inpatient and outpatient facility services as part of a directed payment arrangement approved via a 438.6(c) preprint. The MCPs are responsible for allocating PMPM payments to these providers attributable to the January 1, 2021 through December 31, 2021 incurred period. ODM also instituted a 438.6(c) minimum fee schedule arrangement for COVID-19 diagnostic testing services. MCPs must pay laboratories at 100% of the Medicare rate for COVID-19 testing codes during the rating period. Additionally, the MCPs are required to pay a supplemental per script dispensing fee to retail pharmacies serving MMC enrollees. To determine the amount of the dispensing fee each individual pharmacy is to receive, pharmacies are stratified into three tiers based on total dispensed scripts across all markets. ODM will provide the MCPs with a listing of each pharmacy’s tier assignment and corresponding dispensing fee. Retail pharmacies excluded from this requirement include: 340B covered entities, internet-based pharmacies, mail order pharmacies, and nursing facilities.
