Navigate Medicaid with Updated 340B Medicaid State Profiles Resource

Following Medicaid state billing requirements for 340B correctly is a compliance cornerstone for 340B covered entities. Our 340B Medicaid Profiles by State / Territory resource was created to simplify identification of Medicaid state requirements for billing 340B drugs. This resource was created by layering the most recent 340B-specific Medicaid data and publicly available federal data. A dropdown menu is available for state selection.

This resource offers several primary benefits:

• Pinpoint policies state by state: Navigate between different state Medicaid profiles to locate necessary information for the state(s) that the covered entity bills.
• Differentiate by Medicaid models: Narrow in on the policy as it pertains to the respective Medicaid model, whether it be fee-for-service (FFS) or through a managed care organization (MCO).
• Break down by outpatient setting: Separate state policy based on covered outpatient drug use either in the retail pharmacy setting or provider- or facility-administered transaction setting.
• Identify billing details: Access billing codes, such as bank identification number (BIN), processor control number (PCN), and group numbers for billing retail pharmacy claims.

Reminders:

• Third-Party Payers: Additional requirements or contractual obligations that may be in place from third-party payers are not included in this resource.
• Current State Policy: We suggest checking this tools page for states where your covered entity bills Medicaid to make sure practices are current with state policy.
• Sources: The data presented on this page are compiled from various sources; however, the information is not endorsed by HRSA and is not dispositive with the 340B Drug Pricing Program.
• Stakeholder responsibility: All 340B stakeholders are ultimately responsible for compliance with the 340B Program and all applicable state and federal laws and regulations. Stakeholders are encouraged to contact the states to verify current policies/requirements.

Frequently Asked Questions:

Q: Where do the data for the Medicaid state profile come from?

A: Information for a Medicaid state profile comes from resources and information posted online directly by the state Medicaid agency, Medicaid state plan amendments, or through endorsed vendors for the state Medicaid agency, ensuring that a credible resource has posted the information.

Even though it may be correct and accurate, information shared over a call/webinar, from an email directly to a specific stakeholder, or through outside websites (not directly from states or their endorsed vendors) is not used on a Medicaid state profile, as it cannot be sourced or confirmed to have come directly from the state or authorized representatives.

Q: How often are the data for each state updated?

A: At the beginning of the first and third quarters of the calendar year (i.e., January and July), a full and comprehensive review of each data element on a Medicaid state profile is completed to promote accuracy and currentness of information. Additional continuous surveillance of updates for Medicaid state information occurs to capture updates between comprehensive reviews. Monitoring includes reviews of publications or changes to state policies and reviewing information directly shared by stakeholders with the Prime Vendor Program through Apexus Answers or other communication channels.

Q: How can I learn more about an individual data point on a Medicaid state profile?

A: Each data element provided is a hyperlinked source for your reference. Links are validated regularly. If you find a link that does not work or does not have the information you need, contact Apexus Answers with your feedback.

Q: I see something that does not look right on a Medicaid state profile. What should I do?

A: Contacting the states to verify current policy/requirements is encouraged. Additionally, if information should be updated on the Medicaid state profile, contact ApexusAnswers@340BPVP.com to share the information and source of the clarified details.

Q: Is the information on the Medicaid state profile endorsed by HRSA?

A: The data presented on this page are compiled from various sources; however, the information is not endorsed by HRSA and is not dispositive with the 340B Drug Pricing Program. Stakeholders in 340B are ultimately responsible for 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.

Q: How do I know whom to contact at a specific state Medicaid agency to verify current policy/requirements?

A: Medicaid contact information is listed under each Medicaid state profile. It includes email addresses, mailing addresses, and phone numbers for state contacts for policy, rebates, and technical issues. These contacts are reproduced from contact information state Medicaid agencies have submitted to the Centers for Medicare and Medicaid Services (CMS) contacts page. There may be others at the state Medicaid agency beyond the listed contact on the Medicaid state profile website that can also address questions.

Q: The Medicaid state profile states “PVP unable to find source info to validate data. Please click here if you can provide help.” I have the missing state policy information. What should I do?

A: Additional information is welcomed to broaden the usefulness of the resource to all stakeholders. There are two options to provide this information.