MedicaidReimbursementMedium impact
Supplement 21-06: I.H.S. Tribal 638 Outpatient Pharmacy Reimbursement
New Mexico Medicaid·NM · Pharmacy·Pharmacy
Effective date
Mar 1, 2021
We identified it
Jun 21, 2026
Summary
Effective March 1, 2021, New Mexico Medicaid changed reimbursement for I.H.S. and Tribal 638 outpatient pharmacies to the All-Inclusive Rate (AIR) published annually in the Federal Register. This affects how pharmacy drug claims are processed and reimbursed, with no additional dispensing or administration fees allowed when using the AIR.
Action Required
Billing team should verify that New Mexico Medicaid claims for I.H.S. and Tribal 638 outpatient pharmacy services are being processed at the All-Inclusive Rate rather than previous reimbursement methods. Remove any professional dispensing, pharmaceutical administration, or compounding fee charges when billing pharmacy drug claims for these facilities. Note that durable medical equipment, medical supplies, and over-the-counter orthotic items are excluded from this reimbursement change.