D.C. Mun. Regs. tit. 29, § 2709
Reimbursement for Brand Name Drugs
Effective Jul 27, 201865 DCR 7837Authority: An Act to enable the District of Columbia (“District”) to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes approved December 27, 1967 (81 Stat.774; D.C. Official Code § 1-307.02 (2016 Repl.)), and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)). Source: Final Rulemaking published at 59 DCR 2298 (March 23, 2012); as amended by Final Rulemaking published at 65 DCR 7837 (July 27, 2018).District of Columbia, Office of the Secretary
2709.1 Reimbursement for brand name drugs shall include a professional dispensing fee in the amount of $11.15 and the lesser of:
- (a) The pharmacies' usual and customary charges to the general public; or
- (b) The Actual Acquisition Cost (AAC), which shall be determined by DHCF in accordance with § 2709.2.
2709.2 The AAC shall be determined by DHCF based upon the lesser of:
- (a) The NADAC when available, which shall be published online at https://www.medicaid.gov/medicaid/prescription-drugs/pharmacy-pricing/index.html; or
- (b) The WAC plus zero percent (0%), which shall be kept by drug file pricing compendia vendors or drug databases approved by and in use at the federal level.
SOURCE: Final Rulemaking published at 59 DCR 2298, 2300 (March 23, 2012); as amended by Final Rulemaking published at 65 DCR 7837 (July 27, 2018).