MedicaidReimbursementLow impact
ForwardHealth Update 2026-06: Tribal Federally Qualified Health Centers Can Receive All-Inclusive Rate Reimbursement for Compound Drug Claims
Wisconsin ForwardHealth·WI · Family Medicine, Internal Medicine, General Practice·Pharmacy
Effective date
Mar 23, 2026
We identified it
Jun 18, 2026
Summary
Effective March 23, 2026, Tribal Federally Qualified Health Centers (FQHCs) that choose the all-inclusive rate (AIR) will receive AIR reimbursement for compound drug claims submitted to ForwardHealth for BadgerCare Plus and Medicaid members. The AIR includes all ingredient costs and dispensing fees, with no separate dispensing or repackaging fees reimbursed.
Action Required
By March 23, 2026: Tribal FQHC billing teams must continue using existing pharmacy claim submission requirements when billing compound drug claims for BadgerCare Plus and Medicaid members who choose AIR reimbursement. Ensure no separate dispensing or repackaging fees are billed as these are included in the AIR. Review documentation retention requirements per Wis. Admin. Code § DHS 106.02(9).