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June 10: VDP Formulary, CAD, MCO Search Realignment Now Active

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D-3.4.1. Ends Day 30

PFD staff will estimate the drug's first-year fiscal impact. The PFD analyst:

  1. Determines the drug's pricing methodology
    1. Refer to TAC Section 355.8085 (Subchapter J: Reimbursement Methodology For Physicians And Other Practitioners)
  2. Determines the drug's estimated cost in the first year:
    1. For drugs utilized by new client populations, then the cost estimates are determined using drug dosing and administration guidelines.
    2. For drugs shifting from a currently covered drug, then the cost estimates are based on the currently-covered drug's utilization.
  3. 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).