Pharmacy Rate Setting & Reimbursement
Pharmacy rate setting and reimbursement are critical to ensuring beneficiary access to medications, supporting pharmacy participation, and maintaining the financial integrity of Medicaid, Medicare, and other government-sponsored health care programs. Myers & Stauffer provides independent pharmacy reimbursement consulting and supports federal and state agencies with actual acquisition cost (AAC) programs, National Average Drug Acquisition Cost (NADAC) implementation, state maximum allowable cost (SMAC) methodologies, cost of dispensing (COD) surveys, 340B reimbursement oversight, and Medicaid managed care pharmacy reimbursement. Our expertise in pharmacy pricing, reimbursement methodology development, and pharmacy financial analysis helps agencies strengthen compliance, improve transparency, and develop sustainable reimbursement models that support responsible stewardship of public funds.
Supporting Accurate, Transparent, and Sustainable Pharmacy Reimbursement
Pharmacy reimbursement methodologies directly influence beneficiary access, provider participation, program costs, and compliance with federal requirements. As pharmacy markets continue to evolve, government agencies must ensure reimbursement approaches accurately reflect acquisition costs, dispensing costs, and changing regulatory expectations.
Myers & Stauffer helps government agencies develop, evaluate, and maintain pharmacy reimbursement methodologies that promote transparency, financial accountability, and compliance across Medicaid fee-for-service, Medicaid managed care, and other government-sponsored health programs.
Our team brings extensive experience supporting state and federal agencies in pharmacy pricing, reimbursement analysis, financial modeling, and pharmacy program oversight.
Pharmacy Reimbursement Expertise
We support agencies through all aspects of pharmacy reimbursement design and evaluation, including:
Our work helps agencies establish reimbursement methodologies that are data-driven, defensible, and aligned with federal requirements.
Where We Support Pharmacy Rate Setting
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Accurate reimbursement begins with understanding the prices pharmacies pay to acquire prescription drugs.
We assist states with:
These programs help ensure reimbursement reflects current market conditions and pharmacy acquisition costs.
SMAC programs are a critical tool for managing generic drug reimbursement.
Our services include:
We help agencies establish transparent and sustainable reimbursement methodologies for multisource drugs.
Myers and Stauffer has extensive experience supporting pharmacy pricing initiatives, including long-standing support of CMS’s National Average Drug Acquisition Cost (NADAC) program.
We assist agencies with:
Our experience helps agencies align reimbursement approaches with nationally recognized pricing benchmarks.
Professional dispensing fees remain a critical component of pharmacy reimbursement.
We conduct comprehensive cost of dispensing surveys that support:
Our methodologies provide agencies with objective data to support defensible reimbursement decisions.
340B programs create unique reimbursement and oversight considerations for Medicaid agencies.
We support agencies through:
These efforts help states strengthen oversight while maintaining compliance with federal requirements.
As pharmacy benefits continue to evolve within managed care environments, states must maintain visibility into reimbursement practices applied by managed care organizations and their PBMs.
We assist agencies with:
Our work supports consistent oversight across pharmacy delivery models.
Related Pharmacy Services
Pharmacy reimbursement and pharmacy benefit oversight are closely connected.
Our related services include:
Why Agencies Hire Myers & Stauffer
Our pharmacy reimbursement services combine financial expertise, pharmacy pricing knowledge, advanced analytics, and extensive government program experience.
We bring:
We work closely with agencies to develop reimbursement methodologies that support access, accountability, and long-term program sustainability.
We help government agencies develop and maintain pharmacy reimbursement methodologies that are transparent, data-driven, and compliant with federal requirements. Our focus is on supporting sustainable pharmacy programs that balance access to care with responsible stewardship of public resources.
Connect With Our Team
Partner with experts who understand the complexities of health and human services programs. Let us guide your organization through the industry’s unique challenges and opportunities.
Bobby Courtney, MA, MPH, JD
Principal
Email: bcourtney@mslc.com
Phone Number: 317-815-5475
Allan Hansen
Principal
Email: ahansen@mslc.com
Phone Number: 816-957-6230
In the Words of our Clients…
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