MedicaidReimbursementLow impact
ForwardHealth Update 2026-02: Tribal Federally Qualified Health Centers Can Bill Pharmacy Visits as Encounters
Wisconsin ForwardHealth·WI · Family Medicine·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Effective January 1, 2026, Tribal Federally Qualified Health Centers (FQHCs) in Wisconsin can now bill pharmacy visits as encounters under their All-Inclusive Rate (AIR) reimbursement option. This new policy allows Tribal FQHCs to receive encounter payments for covered outpatient drugs dispensed by their pharmacies, addressing ingredient costs previously excluded from FQHC encounter payments.
Action Required
This policy only affects Tribal Federally Qualified Health Centers in Wisconsin who choose All-Inclusive Rate reimbursement. Most healthcare practices are not affected by this change. Tribal FQHCs should continue using existing billing submission requirements for pharmacy claims through real-time Point-of-Sale systems, Direct Data Entry on ForwardHealth Portal, or Noncompound Drug Claim forms.