Final Action for Reimbursement Changes for Medications Purchased through the 340B Program

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following action regarding reimbursement for medications purchased through the 340B program under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective on or after July 1, 2019, SCDHHS will amend the South Carolina Title XIX State Plan toadopt the following policy changes for drugs purchased through the 340B program, as described in Section 340B of the Public Health Act of 1992:

• For drugs purchased through the 340B program, covered entities must submit a value of “20” in the Submission Clarification Code field (42Ø-DK). 

• Reimbursement for drugs purchased through the 340B program will be provided as an amount not to exceed the 340B ceiling price plus a 340B dispensing fee of $10.50 being submitted in the usual and customary field when submitting these claims to SCDHHS or the provider’s usual and customary charges for providing the medication to the general public, whichever is less.

• Pharmacies contracted with covered entities for the provision of 340B (e.g. contract pharmacies) should not bill SCDHHS for drugs purchased through the 340B program.

SCDHHS projects that based upon the ability to more precisely identify 340B claims, increases to rebate revenue will offset any increase in Medicaid expenditures.

Copies of this notice are available at each SCDHHS Healthy Connections Medicaid Office and at www.scdhhs.gov for public review. Additional information regarding these actions is available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at the SCDHHS, Division of Behavioral Health, Jefferson Square Building, 1801 Main Street, Columbia, South Carolina, Monday through Friday between 9 a.m.-5 p.m.