Searchable state-by-state Medicaid 340B requirements
This resource has been created by the 340B Prime Vendor Program to assist stakeholders by combining the most recently available 340B-specific Medicaid data with publicly available federal data. Please note that additional requirements or contractual obligations that may be in place from third-party payers are not included in this resource.
Upon selecting a state in the drop-down menu, the Medicaid State Technical, Rebate and Policy contacts and details on the state’s retail prescriptions, provider- or facility-administered drugs, contract pharmacies and Medicaid Managed Care profiles will populate below. Each field is linked to the sourced data where additional information can be found.
Please note: The data presented on this page are compiled from various sources; however, the information is not endorsed by HRSA and not dispositive with the 340B Drug Pricing Program. 340B stakeholders are ultimately responsible for 340B Program compliance and compliance with all applicable state and federal laws and regulations. Stakeholders are encouraged to contact the states to verify current policy/requirements.
Technical contact
PR HEALTH INSURER ADMINISTRATION (PRHIA)
addie mercado
AMERCADO@ASESPR.ORGcalle alda 1549 sector el cinco
san juan, PR 00919
(787) 474-3300
Rebate contact
PR HEALTH INSURER ADMINISTRATION (PRHIA)
carmen rodriguez
CLETICIA@ASESPR.ORGcalle alda 1549 sector el cinco
san juan, PR 00919
(787) 474-3300
Policy contact
ASES
roxanna rosario serrano
RROSARIO@ASESPR.ORGcalle alda 1549 sector el cinco
san juan, PR 00919
(787) 474-3300
Puerto Rico Medicaid State Details as of 29-AUG-24
Retail Pharmacy Transactions - Fee For Service (FFS)
Drug Cost (submissions)
Drug cost type when 340B drugs are dispensed.
Drug Cost (reimbursements)
Drug cost type state plans reimburse at for 340B dispenses.
Required Claim Identifiers
Claim identifiers required to indicate 340B drugs were dispensed.
Professional Dispensing Fee (PDF)
The current professional dispensing fee for FFS 340B claims. Note: some states have ranges based on different factors.
Provider or Facility Administered Transactions Fee For Service (FFS)
Drug Cost (submissions)
Drug cost type when 340B drugs are administered.
Drug Cost (reimbursements)
Drug cost type state plans reimburse at for 340B dispenses.
Required Claim Identifiers
Claim identifiers required to indicate 340B drugs were administered.
Contract Pharmacies*
* Despite Federal position on dispensing through CP arrangements
Medicaid Managed Care Organization (MCO) Information
State uses MCO plans?
Does the state use MCO(s) to manage Medicaid services?
|
MMCO Plans/Vendors |
Pharmacy Benefit Managers (PBMs) |
|---|---|
Unless otherwise specified, payment for carved-out-fee-for-service drugs is the lowest of: 1) the actual acquisition costs of the drugs plus a professional dispensing fee; or 2) the state-established maximum allowable cost (MAC), plus a professional dispensing fee; 3) the provider’s usual and customary charge to the general public.