MedicaidReimbursementHigh impact
Implementation of New Pharmacy Pricing Methodology Using National Drug Acquisition Cost (NADAC) Files and New Dispensing Fee
Connecticut Medicaid (HUSKY Health)·CT·Pharmacy
Effective date
Apr 1, 2017
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid is implementing a new pharmacy pricing methodology using National Average Drug Acquisition Cost (NADAC) files and significantly increasing the dispensing fee from $1.40 to $10.75 for most pharmacies. The state's Maximum Allowable Cost (MAC) pricing will be discontinued, and new pricing rules will apply to various drug categories including coagulation factors.
Action Required
By April 1, 2017: Billing team must update pharmacy billing systems to reflect new dispensing fee of $10.75 (increased from $1.40) for Connecticut Medicaid claims. Update system to use NADAC pricing methodology instead of state MAC pricing for drug reimbursement. Ensure coagulation Factor VII, IX, and X drug claims include actual purchase invoices alongside pharmacy claims for proper reimbursement. Verify OTC medication billing includes complete package sizes to avoid denials.