Gross Amount Due

The "Gross Amount Due" (GAD) field (430-DU) reflects the pharmacy's usual and customary price less discount or special price.

Claims submitted with a GAD value greater than or equal to $10,000 will reject with NCPDP code “DU” (“M/I Gross Amount Due”), and the dispensing pharmacy must contact VDP for an override. Refer to the Pharmacy Claim Processing section to contact the Pharmacy Benefits Access Help Desk.

If the submitted Usual and Customary or Gross Amount Due values are less than the allowed charge for the claim, HHSC will pay the lesser of the two (minus any copay).