Date

Missouri Maximum Allowable Cost (MAC) Pricing Inquiry

Providers may contact Pharmacy and Clinical Services at (573) 751-6963 to request review of a MAC rate.  If the MO HealthNet Division (MHD) determines there is a rate change, it will be made effective the date of review. 

If further review is necessary, the provider must submit a completed MAC Pricing Inquiry Worksheet and a copy of the invoice for the National Drug Code (NDC) in question.  Providers should NOT include Protected Health Information (PHI) on the worksheet.  Providers may only submit a worksheet upon request by the MHD and only for the drug(s) specified.  Upon completion of the review, the MHD will notify providers of the outcome.  If there is a rate change, it will be effective the date the MHD received the worksheet.  Providers may then resubmit claims for appropriate reimbursement. 

The Missouri Maximum Allowable Cost (MAC) pricing list can be found at dss.mo.gov/mhd/cs/pharmacy/pages/mac.htm. 

National Average Drug Acquisition Cost (NADAC) Pricing Inquiry

Providers may contact the NADAC Help Desk to request review of a NADAC rate or to provide notification of recent drug price changes.

Contact the NADAC Help Desk through the following means:

Provides must submit a completed Help Desk Form and a copy of the invoice for the NDC in question.  The Help Desk will not address specific state claim reimbursement related questions or concerns.

The NADAC rate file is updated on a weekly basis.  There may be a delay between the release of the weekly NADAC rate file and the MHD receiving the file.  If there is a rate change, it will reflect the effective date found on the NADAC file.  Providers may then resubmit claims for appropriate reimbursement.

Please note the MHD does not set the NADAC rate and does not review NADAC pricing inquiries.  The Centers for Medicare & Medicaid Services (CMS) has entered into a contract with Myers & Stauffer, LC, to perform these services.  

The NADAC pricing file can be found at data.medicaid.gov/Drug-Pricing-and-Payment/NADAC-National-Average-Drug-Acquisition-Cost-/a4y5-998d.  More information about NADAC and the Retail Pricing Survey may be found on the Medicaid.gov website.