Pharmacy Audit Integrity

In 2017, using actual acquisition cost as the basis for its reimbursement methodology. Remember, NADAC is a benchmark developed by consistently surveying retail community pharmacies across the country, collecting data on outpatient drug ingredient costs. It’s been around since 2013 and is often updated on a weekly basis. 

A quick note: If NADAC is not available for a drug, the law calls for Wholesale Acquisition Cost (WAC) to be the reimbursement methodology. PBMs and insurance companies may claim that increased dispensing fees are the driver of higher pharmacy costs, but this is a red herring. The real drivers of higher pharmacy costs are PBMs and their spread pricing tactics, which means charging a health plan more for a drug than the pharmacy is paid. If your company has a health plan, ask your PBM if your health plan is being charged the same amount for your drugs that the pharmacy is being paid. If not, your plan is being taken advantage of.