D-3.4.1. Ends Day 30
PFD staff will estimate the drug's first-year fiscal impact. The PFD analyst:
- Determines the drug's pricing methodology
- Refer to TAC Section 355.8085 (Subchapter J: Reimbursement Methodology For Physicians And Other Practitioners)
- Determines the drug's estimated cost in the first year:
- For drugs utilized by new client populations, then the cost estimates are determined using drug dosing and administration guidelines.
- For drugs shifting from a currently covered drug, then the cost estimates are based on the currently-covered drug's utilization.
- Calculates the Federal Financial Participation and estimated General Revenue (GR) cost by multiplying the estimated first-year cost by the Federal Medical Assistance Percentages (FMAP).