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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, 2026
Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
Sep 4, 2026
Summary
Starting October 1, 2026, Nevada Medicaid Fee-For-Service will incorporate the 340B ceiling price into its outpatient drug reimbursement methodology. When the 340B ceiling price is the lowest applicable value in the established drug reimbursement logic, it will be used for reimbursement calculations. Covered entities must ensure their 340B Acquisition and Accountability Cost (AAC) is submitted 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 · 8 steps
01Billing team must review and update all 340B drug billing processes to account for 340B ceiling price integration.
02Verify that 340B AAC has been submitted to Nevada Medicaid and is current; coordinate with pharmacy/materials management to confirm submission.
03Update billing software logic or documentation to reflect that reimbursement may be calculated using the 340B ceiling price when it is the lowest applicable value.
04Establish internal process for tracking 340B ceiling price calculations using AMP and URA values from HRSA resources.
05Train billing staff on the new methodology and direct them to reference the Nevada Medicaid and Nevada Check Up Pharmacy Manual for 340B billing guidelines.
06Document the policy change in internal procedures and compliance files.
07For pricing disputes related to 340B ceiling prices, direct inquiries to the HRSA 340B Administrative Dispute Resolution process rather than using standard Nevada Medicaid dispute channels.
08Contact RxInfo@nvha.nv.gov with policy and billing questions.
If missed: Failure to implement these changes may result in claim denials or reimbursement at incorrect rates beginning October 1, 2026.
Original notice
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, 2026
medicaid.nv.gov · Always check the source before changing claims.