MedicaidReimbursementMedium impact
KMAP BULLETIN: Reimbursement for Approved Dispense as Written (DAW) Pharmacy Claims
Kansas Medicaid (KanCare)·KS · Pharmacy·Pharmacy
Effective date
Jun 1, 2022
We identified it
Jun 21, 2026
Summary
KMAP (Kansas Medicaid) updated reimbursement methodology for Dispense as Written (DAW) pharmacy claims with approved Brand Medical Necessity Prior Authorization, effective retroactively to June 1, 2022. The drug ingredient cost will now be reimbursed at the lowest of four options including the new National Average Drug Acquisition Cost (NADAC), plus a $10.50 professional dispensing fee.
Action Required
Immediately: Billing team should review current DAW pharmacy claims processing to ensure reimbursement calculations align with the updated methodology using NADAC as one of the four lowest-cost options. Update billing system logic if needed to account for the $10.50 dispensing fee structure. Review Section 8400, page 8-15 of the updated Pharmacy Fee-for-Service Provider Manual for detailed implementation guidance.