As the manager of a community pharmacy practice, you are notified that a third party player (HealthUSA) is changing their formula for how they plan to reimburse the pharmacy for medications dispensed from an AWP-based reimbursement to a WAC-based reimbursement. This update will take place when the new contract goes into effect on January 1. The current formula is AWP-22% + 1.50 (dispensing fee) The new formula is WAC + 1% + $1.00 (dispensing fee) They are the pharmacy benefits manager for approximately 25% of your patients. The average AWP for the pharmacy is currently $63.55, and the average WAC for the pharmacy is currently $47.75. 

Answer the following questions: -

How much will each plan reimburse on average per prescription given the pharmacy's current averages? -

Should a differential analysis be conducted when evaluating this new contract to determine if it should be accepted, and why? -

What additional information would be needed if a differential analysis is going to be completed?

Answer rating: 100% (QA)

To calculate the reimbursement per prescription under the current and new formulas we can use the pr... View the full answer