Notice2021-11624
VA's Indian Health Service/Tribal Health Program Reimbursement Agreements Program-Pharmacy Reimbursement Rate for the Lower 48 States
Primary source
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Published
June 3, 2021
Issuing agencies
Veterans Affairs Department
Abstract
VA, Veterans Health Administration (VHA) will facilitate a tribal consultation regarding VA's Indian Health Service/Tribal Health Program (IHS/THP) Reimbursement Agreements Program. VA is seeking input on adopting a pharmacy reimbursement rate for the lower 48 states.
Full Text
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<title>Federal Register, Volume 86 Issue 105 (Thursday, June 3, 2021)</title>
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[Federal Register Volume 86, Number 105 (Thursday, June 3, 2021)]
[Notices]
[Page 29882]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2021-11624]
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DEPARTMENT OF VETERANS AFFAIRS
VA's Indian Health Service/Tribal Health Program Reimbursement
Agreements Program--Pharmacy Reimbursement Rate for the Lower 48 States
AGENCY: Department of Veterans Affairs.
ACTION: Notice of Tribal Consultation Session.
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SUMMARY: VA, Veterans Health Administration (VHA) will facilitate a
tribal consultation regarding VA's Indian Health Service/Tribal Health
Program (IHS/THP) Reimbursement Agreements Program. VA is seeking input
on adopting a pharmacy reimbursement rate for the lower 48 states.
DATES: Comments must be received by VA on or before July 5, 2021.
ADDRESSES: Comments may be submitted to
<a href="/cdn-cgi/l/email-protection#83f7f1eae1e2efe4ecf5e6f1edeee6edf7e0ecedf0f6eff7e2f7eaecedc3f5e2ade4ecf5"><span class="__cf_email__" data-cfemail="dfabadb6bdbeb3b8b0a9baadb1b2bab1abbcb0b1acaab3abbeabb6b0b19fa9bef1b8b0a9">[email protected]</span></a> or by mail at Department of
Veterans Affairs, Suite 915L, 810 Vermont Avenue NW, Washington, DC
20420.
FOR FURTHER INFORMATION CONTACT: Kara Hawthorne, IHS/THP Program
Manager, VA Office of Community Care, at <a href="/cdn-cgi/l/email-protection#4f1b3d262d2e23610e283d2a2a222a213b3c0f392e61282039"><span class="__cf_email__" data-cfemail="4b1f3922292a27650a2c392e2e262e253f380b3d2a652c243d">[email protected]</span></a>, or
by telephone at 303-780-4826. (This is not a toll-free number.)
SUPPLEMENTARY INFORMATION: Utilizing the authorities found in 25 U.S.C.
1645(c), Sharing Arrangements with Federal Agencies, and 38 U.S.C.
8153, Sharing of Health-Care Resources, VA, IHS and Tribal health care
providers have created the IHS/THP Reimbursement Agreements Program.
This program provides a means for IHS and THP health facilities to
receive reimbursement from VA for direct care services, including
pharmaceutics, provided to eligible American Indian/Alaska Native (AI/
AN) Veterans. Currently, reimbursement agreements under this program
state that VA will reimburse ``actual costs'' for pharmaceuticals. In
implementing this requirement, VA has realized that this term, ``actual
costs,'' may be ambiguous and has led to difficulties in administering
the agreements in compliance with applicable laws. VA is considering
replacing the term ``actual cost'' with a more recognizable and easily
calculated rate. Selecting an industry standard pharmaceutical rate
structure would benefit IHS/THP sites by making it easier to understand
and predict the reimbursement rate by eliminating the need to calculate
actual cost.
VA is proposing two distinct pharmacy payment rates for IHS and THP
facilities. For IHS facilities, VA has collaborated with IHS to use the
Federal Supply Schedule (FSS) or other established contract vehicles
(i.e., joint national drug contracts) pharmaceutical pricing as the
proposed reimbursement rate, as most of their pharmaceuticals are
purchased using the FSS contract or other contract vehicles. The FSS
contract and other contract vehicles are collectively referred to as
the FSS rate. For those pharmaceuticals not available on FSS, or non-
contracted drugs, claims will be paid based on the adopted rate that is
agreed upon with THPs.
For THP facilities, VA is suggesting using one of two industry-
standard pharmacy reimbursement methodologies. These proposed
methodologies are: (1) Wholesale Acquisition Cost (WAC) plus dispensing
fee and (2) Average Wholesale Price (AWP), minus discount, plus
dispensing fee.
This written tribal consultation is seeking input on the preferred
pharmacy reimbursement rate from the options above. VA suggests the
following questions for response:
(1) For the rates for THP facilities, what is your preferred
methodology, WAC plus dispensing fee, or (2) AWP, minus discount, plus
dispensing fee.
(2) For the rates for THP facilities, if you identify AWP as the
preferred method, what would you propose as the AWP discount percent
rate for generic drugs and name brand/specialty drugs? How did you
calculate or determine the proposed discount percent rate?
(3) For THP dispensing fee, VA proposes to adopt an amount in line
with industry standard, which is generally less than $1.00 per drug, to
be applied to either selected rates (WAC or AWP). Do you agree with
$1.00 per drug for a dispensing fee? If not, what do you propose the
dispensing fee should be? How did you calculate or determine the
proposed dispensing fee?
(4) Do you have any comments on pharmacy reimbursement rates for
IHS facilities and/or the related claims submission and reimbursement
process?
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved this
document on May 26, 2021, and authorized the undersigned to sign and
submit the document to the Office of the Federal Register for
publication electronically as an official document of the Department of
Veterans Affairs.
Luvenia Potts,
Regulation Development Coordinator, Office of Regulation Policy &
Management, Office of General Counsel, Department of Veterans Affairs.
[FR Doc. 2021-11624 Filed 6-2-21; 8:45 am]
BILLING CODE 8320-01-P
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