(pursuant to §1902(a)(13) of the Act (U.S.C. 1396a(a)(13))

 

THE VIRGINIA STATE PLAN FOR MEDICAL ASSISTANCE

 

The Virginia Department of Medical Assistance Services (DMAS) hereby affords the public notice of its intention to amend the Virginia State Plan for Medical Assistance to provide for changes to the Methods and Standards for Establishing Payment Rates—Other Types of Care, Fee-for-service providers: pharmacy.  The Department intends to implement a specialty drug reimbursement methodology based upon the Wholesale Acquisition Cost (WAC) of designated specialty drugs. Specialty drug products are products used to treat chronic, high-cost or rare diseases, including drugs for the treatment of certain diseases such as Hepatitis-C, and Multiple Sclerosis, as well as drugs such as growth hormone agents and interferon. These drugs tend to be much higher in cost than standard pharmaceutical products, and this action implements a new methodology to help contain the higher costs associated with these drugs. The new methodology, described in a new subsection (10) of 12 VAC 30-80-40, is a formula based upon the Wholesale Acquisition Cost (WAC) of these specialty drugs. The methodology computes a price above a given percentage of the WAC for each specified drug. The current percentage value is 4.7%. This change is being made pursuant to the Department’s authority under Title XIX of the Social Security Act. 

 

This notice is intended to satisfy the requirements of 42 C.F.R. 
§ 447.205 and of § 1902(a)(13) of the Social Security Act, 42 U.S.C. § 1396a(a)(13). A copy of this notice is available for public review from Rachel Cain, Health Care Services Division, Pharmacy Unit, DMAS, 600 Broad Street, Suite 1300, Richmond, VA 23219, and this notice is available for public review on the Regulatory Town Hall (www.townhall.com). Comments or inquiries may be submitted, in writing, within 30 days of this notice publication to Ms. Cain and such comments are available for review at the same address.