OAR 410-121-0160
Dispensing Fees

(1)

Effective January 1, 2018, professional dispensing fees allowable for services shall be reimbursed as follows:

(a)

All enrolled chain affiliated pharmacies with ten or more pharmacies under common ownership shall be reimbursed at a rate of $9.80 per claim. A “chain affiliated pharmacy” shall be defined as a pharmacy that is part of a group of pharmacies under common ownership and does not include fully independent pharmacies or franchise pharmacies;

(b)

Independently owned pharmacies in communities that are the only enrolled pharmacy within a fifteen (15) mile radius from another pharmacy shall be reimbursed at a dispensing fee of $14.30 per claim;

(c)

All 340B pharmacies operated by a 340B covered entity shall be reimbursed at a rate of $14.30 per claim;

(d)

All other enrolled independently owned pharmacies excluding those in 410-121-0160 (Dispensing Fees)(b) and (c) shall be reimbursed based on an individual pharmacy’s annual claims volume as follows:

(A)

Less than 30,000 claims a year = $14.30;

(B)

Between 30,000 and 69,999 claims per year = $11.91;

(C)

70,000 or more claims per year = $9.80.

(2)

All Division enrolled independent pharmacies shall be required to complete an annual survey that collects claim volumes from enrolled pharmacies and other information from the previous 12-month period to determine the appropriate dispensing fee reimbursement:

(a)

Claims volume shall be stated by total OHP covered prescriptions and claims from all payer types;

(b)

Survey activities shall be conducted by either the Division or its contractor and must be completed and returned by pharmacies within 14 days of receipt;

(c)

Completed surveys must be signed with a letter of attestation by the store owner or majority owner;

(d)

Pharmacies that fail to respond to the survey or do not include the letter of attestation shall default to the lowest dispensing tier;

(e)

Once a tier is established for a calendar year, the pharmacy’s dispensing fee shall remain in that tier until the next annual claims volume survey is conducted;

(f)

Newly enrolled 340B pharmacies shall be reimbursed at a rate of $14.30 per claim. All other independent pharmacies shall be defaulted to the lowest dispensing tier until the next claims volume survey is conducted.

(3)

All chain affiliated pharmacies shall be exempt from completing the annual claims volume survey.
[Publications referenced are available from the agency.]

Source: Rule 410-121-0160 — Dispensing Fees, .

410‑121‑0000
Foreword and Definition of Terms 410‑121‑0021
Organizations Authorized to Provide Pharmaceutical Prescription Services 410‑121‑0030
Practitioner-Managed Prescription Drug Plan 410‑121‑0032
Supplemental Rebate Agreements 410‑121‑0033
Polypharmacy Profiling 410‑121‑0040
Prior Authorization Required for Drugs and Products 410‑121‑0060
How to Get Prior Authorization for Drugs 410‑121‑0061
Durable Medical Equipment, Medical Supplies, and Medical Surgical Services (Physician Administered Drugs) 410‑121‑0100
Drug Use Review 410‑121‑0111
Pharmacy and Therapeutics Committee 410‑121‑0135
Pharmacy Management Program 410‑121‑0143
Client Confidentiality 410‑121‑0145
Prescription Requirements 410‑121‑0146
Dispensing Limitations 410‑121‑0147
Exclusions and Limitations 410‑121‑0148
Dispensing in a Nursing Facility or Community Based Care Living Facility 410‑121‑0150
Billing Requirements 410‑121‑0155
Reimbursement 410‑121‑0157
Participation in the Medicaid Drug Rebate Program 410‑121‑0160
Dispensing Fees 410‑121‑0185
Pharmacy Based Immunization Delivery 410‑121‑0190
Medication Therapy Management Services and Clozapine Therapy Monitoring 410‑121‑0200
Billing Forms 410‑121‑0220
Instructions for Completion of the Prescription Drug Invoice 410‑121‑0280
Billing Quantities, Metric Quantities and Package Sizes 410‑121‑0300
CMS Federal Upper Limits for Drug Payments 410‑121‑0420
DESI Less-Than-Effective Drug List 410‑121‑0580
Oregon Medicaid and Pharmaceutical Manufacturers’ Dispute Resolution Procedures 410‑121‑0625
Items Covered in the All-Inclusive Rate for Nursing Facilities
Last Updated

Jun. 8, 2021

Rule 410-121-0160’s source at