Medicaid Fee-for-Service Drug Payment (Lowest-Of)
Medicaid fee-for-service payment for a drug as the lowest of several amounts.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- State actual acquisition cost, per unit
- 0.2 dollars
- Quantity
- 90 units
- State professional dispensing fee
- 10.5 dollars
- Usual and customary charge for the prescription
- 40 dollars
Result: Lowest-of payment $28.50.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- State actual acquisition cost, per unit
- Quantity
- State professional dispensing fee
- Usual and customary charge for the prescription
- Federal upper limit, per unit, if the drug has one
- State maximum allowable cost, per unit, if any
- Amount paid
How this is calculated
Citation
42 CFR 447.512(b): payment for drugs without a specific limit may not exceed the lower of actual acquisition cost plus a professional dispensing fee, or the usual and customary charge. 42 CFR 447.514(b): the federal upper limit for listed multiple source drugs. 42 CFR 447.502: definitions. Read the sources: 42 CFR 447.512 ↗, 42 CFR 447.514 ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.