OAR 410-121-0300
CMS Federal Upper Limits for Drug Payments

(1)

The Centers for Medicare and Medicaid Services (CMS) Federal Upper Limits for Drug Payments listing of multiple source drugs meets the criteria set forth in 42 CFR 447.332 and 1927(e) of the Act as amended by OBRA 1993 and the DRA 2005.

(2)

Payments for multiple source drugs must not exceed, in the aggregate, payment levels determined by applying to each drug entity a reasonable dispensing fee (established by the State and specified in the State Plan), plus an amount based on the limit per unit. CMS has determined the amount based on the limit per unit to be equal to 250 percent of the Average Manufacturer’s Price (AMP). CMS will post the AMP to a Website available to the public on a quarterly basis.

(3)

The FUL drug listing is published in the State Medicaid Manual, Part 6, Payment for Services, Addendum A. The most current Transmittals and subsequent changes are posted to the CMS website https://www.medicaid.gov/medicaid/prescription-drugs/pharmacy-pricing/index.html.

Source: Rule 410-121-0300 — CMS Federal Upper Limits for Drug Payments, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-121-0300.

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 410-121-0300’s source at or​.us