How does the recent settlement in the First Databank lawsuit affect the lowest third party reimbursement?

The First Databank settlement went into effect on September 26 and rolls back (lowers) AWPs for 8000 or more drugs by up to just more than 4%. The result is that reimbursement for the drug will also be reduced unless there isn’t an adjustment to the formula. Most third party plans adjusted their contracts in advance of the settlement to reduce the impact of the settlement on pharmacy profit margins (Medi-Cal did not).

For example, an AWP minus 17% contract would typically be adjusted to somewhere around AWP minus 13.5%. Information obtained from your PSAO or contracting group should reflect these changes. If you have a direct contract with a third party payer, you need to check to see if the newly adjusted rates were put into place.

4. What are the mechanics of making these changes in the pharmacy? Pharmacy computer systems usually have some sort of payment formula associated with individual third party plans.

You should contact your computer software vendor to identify how that ... more.

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