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Attention Nevada Medicaid-enrolled 340B Covered Entities: Nevada Medicaid Fee-For-Service (FFS) Will Integrate the 340B Ceiling Price into the 340B Reimbursement Methodology Beginning October 1, 2026
Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
Jul 28, 2026
Summary
Effective October 1, 2026, Nevada Medicaid Fee-for-Service will integrate the 340B ceiling price into its outpatient drug reimbursement methodology. When the 340B ceiling price (calculated from Average Manufacturer Price and Unit Rebate Amount) is the lowest applicable value in the reimbursement logic, it will be used for reimbursement. Covered entities must submit their 340B Actual Acquisition Cost (AAC) to Nevada Medicaid, and pricing disputes must follow HRSA's 340B Administrative Dispute Resolution process.
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What to do
by Sep 30, 2026 · 5 steps
01Billing team must verify that the practice's 340B AAC has been submitted to Nevada Medicaid and confirm submission status with RxInfo@nvha.nv.gov.
02Update billing system logic to recognize that 340B ceiling prices may now be applied as the reimbursement basis for qualifying 340B outpatient drug claims when they represent the lowest applicable value.
03Pharmacy staff and billing team must review HRSA's 340B Ceiling Price Calculation methodology and the 340B Administrative Dispute Resolution process on the HRSA website.
04Establish internal process for handling pricing disputes: if ceiling price reimbursement appears incorrect, disputes must be submitted through HRSA's formal Administrative Dispute Resolution process, not directly to Nevada Medicaid or Prime Therapeutics.
05Update pharmacy manual references and staff training to reflect new reimbursement methodology.
If missed: Failure to submit AAC or properly route disputes will result in claim denials or payment delays.
Original notice
Attention Nevada Medicaid-enrolled 340B Covered Entities: Nevada Medicaid Fee-For-Service (FFS) Will Integrate the 340B Ceiling Price into the 340B Reimbursement Methodology Beginning October 1, 2026
medicaid.nv.gov · Always check the source before changing claims.
Related changes
See all Nevada Medicaid changes →Attention Nevada Medicaid-enrolled 340B Covered Entities: Reminder: Nevada Medicaid Fee-For-Service (FFS) Will Integrate the 340B Ceiling Price into the 340B Reimbursement Methodology Beginning October 1, 2026HighEffective Oct 1, 2026 · ReimbursementBrowse every Nevada Medicaid change in the policy list