MedicaidBilling CodesMedium impact
KMAP BULLETIN: HRSA 340B Rebate Model Pilot Program FAQ Bulletin
Kansas Medicaid (KanCare)·KS · Pharmacy·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 21, 2026
Summary
Starting January 1, 2026, medications in HRSA's 340B Rebate Model Pilot Program must be billed using the 340B ceiling price as the Actual Acquisition Cost (AAC), not the upfront Wholesale Acquisition Cost (WAC). This affects Medicaid billing for covered outpatient drugs where the true cost is realized after rebate payment.
Action Required
Before January 1, 2026: Billing team must update pharmacy billing systems to use 340B ceiling prices from manufacturer-provided files available on the rebate model IT platform for Medicaid claims involving 340B eligible drugs. Download and implement the 340B ceiling price file feed to ensure accurate acquisition cost billing. Verify pricing accuracy using the 340B OPAIS pricing component.