HCFA has submitted a program release (#91, 8/4/99) to all State Medicaid Directors to bill the Unit of Measurement (UOM) for the product Lovenox Prefilled Syringe by ONE EACH SYRINGE. This change is necessary due to RPR having experienced numerous disputes due to pharmacies being unable to accommodate the metric decimal quantity and bill correctly by the milliliter in the Medicaid Rebate Program. State Medicaid's must adhere to HCFA changes. However, the pricing compendia, First Data Bank (FDB) reports the product by a milliliter, which is the NCPDP standard.
It was noted that before RPR requested this UOM change, they surveyed Medicaid pharmacists that preferred to have the product UOM by the syringe versus the milliliters. The work group discussed this QUIC request, which has come before the group several times. It was noted that the rebate program is unit of measure intense and especially problematic without pharmacies, payers and manufacturers using metric decimal quantities.
The work group voted to apply the standard as written and to send a letter to Martha McNeil, Texas Medicaid, to explain the decision. The work group stressed the need for marketing the NCPDP Billing Unit Standard to HCFA and manufacturers, which may help, prevent these issues in the future