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National Average Drug Acquisition Cost (NADAC) Reimbursement - Reminder

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Explains MedImpact's use of the CMS National Average Drug Acquisition Cost (NADAC) benchmark for Kentucky Medicaid pharmacy reimbursements, describes NADAC update cadence and sources, and outlines impacts and processes for claim reversal/resubmission. Applies to Kentucky Medicaid pharmacy providers served by MedImpact.

Policy Summary

Payermedimpact

PolicyNational Average Drug Acquisition Cost (NADAC) Reimbursement - Reminder

Policy CodePolicy N/A

Change TypeInformational reminder

Effective DateJul 9, 2026

Next Review DateN/A

Key ActionIf your acquisition cost increased after a NADAC update, consider reversing and resubmitting affected claims while understanding this may temporarily reduce weekly payments until EOB cycles complete.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

weeklyNADAC updates posted by CMS

FridayMedImpact loads updated NADAC prices into adjudication system

1CMS NADAC vendor: Myers & Stauffer contact provided

potential temporary reductionPayment impact from reversal and resubmission

NADAC Reimbursement Guidance

NADAC reimbursement guidance

Reimbursement is governed by Kentucky DMS fee-for-service methodology using the CMS-published National Average Drug Acquisition Cost (NADAC). MedImpact loads updated NADAC weekly and cannot modify CMS-published NADAC values. Providers may review CMS NADAC files and may choose to reverse/resubmit claims when their acquisition cost changed, understanding timing and payment impacts.

MedImpact reimburses providers per Kentucky Department for Medicaid Services (DMS) fee-for-service methodology using NADAC as the pricing benchmark; NADAC is maintained and published by CMS and cannot be changed by MedImpact or DMS.

NADAC updates are posted weekly (Wednesdays) by CMS (Myers & Stauffer conducts maintenance) and MedImpact loads the updated weekly NADAC prices into its claim adjudication system the following Friday.

For brand products, updated NADAC prices may be backdated to the effective date of the manufacturer WAC or AWP increase; compendia (e.g., First Databank, Medi-Span) incorporate the updated NADAC files into their Medicaid pricing modules.

Providers may review the CMS weekly NADAC Comparison files (which show new and old NADAC price and effective date) and compare posted NADAC rates with their product invoices before deciding to reverse and resubmit claims.

Reversal and resubmission of claims due to changed NADAC pricing can temporarily reduce expected weekly payments because reversals from a previous EOB cycle create accounts receivable applied to the next payment; resubmitted claims must proceed through the standard EOB cycles and payment is received in a subsequent cycle.

For NADAC data questions contact the CMS NADAC vendor Myers & Stauffer (info@mslcrps.com or 855-457-5264). For program or claim questions use the KY MCO or KY FFS contact portals provided by MedImpact.

Pharmacy Routing Identifiers

Pharmacy routing identifiersmixed

BIN: 023880 / PCN: KYPROD1 / GROUP: KYM01	Kentucky MCO pharmacy routing identifiers
BIN: 026309 / PCN: KYPROD1 / GROUP: KYF01	Kentucky FFS pharmacy routing identifiers

Actions for Providers — Reversals, Resubmissions, and Support

Denial Risk

Reversal and resubmission advisory

Providers may reverse and resubmit claims when their acquisition cost increased after a CMS NADAC update; however, reversals and resubmissions can cause a temporary reduction in expected weekly payments because reversals from a previous EOB cycle create accounts receivable that are applied to the next provider payment. Payments from resubmitted claims will be processed through the standard EOB cycle and received in a subsequent payment cycle.

Reversal/resubmission may reduce the weekly payment received after the reversal is submitted until the resubmitted claim completes the EOB cycle.
Once the resubmission processes through the EOB cycle, the payment will be received in the next payment cycle.

Prior Authorization

KY MCO and KY FFS support / prior authorization contacts

For questions about program operations, prior authorizations, or claim support, use the KY MCO or KY FFS contact channels below. Prior authorization requests and help desk support are available by phone, fax, and the KY pharmacy portal.

KY MCO — Program questions: KYMCOPBM@MedImpact.com; Pharmacy Help Desk: (800) 210-7628 (24/7); Prior Authorizations Phone: (844) 336-2676 (8:00 AM–7:00 PM EST, 7 days/week); Prior Auth Fax: (858) 357-2612; Pharmacy Portal: https://kyportal.medimpact.com/; BIN: 023880 / PCN: KYPROD1 / GROUP: KYM01
KY FFS — Program questions: KYMFFS@MedImpact.com; Pharmacy Help Desk: (877) 403-6034 (24/7); Prior Authorizations Phone: (877) 403-6034 (8:00 AM–7:00 PM EST, 7 days/week); Prior Auth Fax: (858) 357-2612; Pharmacy Portal: https://kyportal.medimpact.com/; BIN: 026309 / PCN: KYPROD1 / GROUP: KYF01

Benchmark Definitions

inv-05: National Average Drug Acquisition Cost (NADAC)

DefinitionNational Average Drug Acquisition Cost (NADAC) — a CMS‑published pricing benchmark reflecting average provider acquisition cost; maintained by CMS (Myers & Stauffer conducts maintenance).

Update cadenceNADAC updates are posted to the CMS website weekly (every Wednesday) and incorporated into MedImpact systems the following Friday.

Role in Kentucky reimbursementMedImpact reimburses providers per Kentucky DMS fee‑for‑service methodology which uses NADAC as the pricing benchmark; neither MedImpact nor DMS can adjust NADAC values.

Relationship to compendiaDrug compendia (e.g., First Databank, Medi‑Span) ingest the weekly NADAC file and update their Medicaid pricing modules accordingly.

Effective dates/backdatingFor brand products, updated NADAC prices may be backdated to the effective date of the WAC or AWP increase as reflected in CMS/M&S files.

inv-06: WAC and AWP

DefinitionWholesale Acquisition Cost (WAC) and Average Wholesale Price (AWP) — manufacturer pricing benchmarks that commonly drive increases in NADAC for brand products.

Timing impactUpdated brand NADAC prices are typically reflective of increases in WAC and AWP from the previous week.

Reimbursement consequenceManufacturer increases in WAC/AWP can lead to updated NADAC values which may affect provider reimbursement for newly purchased inventory.

Policy Summary

Payermedimpact

PolicyNational Average Drug Acquisition Cost (NADAC) Reimbursement - Reminder

Policy CodePolicy N/A

Change TypeInformational reminder

Effective DateJul 9, 2026

Next Review DateN/A

SourceLink

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National Average Drug Acquisition Cost (NADAC) Reimbursement - Reminder

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NADAC Reimbursement Guidance

NADAC reimbursement guidance

Actions for Providers — Reversals, Resubmissions, and Support

Denial Risk

Reversal and resubmission advisory

Reversal/resubmission may reduce the weekly payment received after the reversal is submitted until the resubmitted claim completes the EOB cycle.
Once the resubmission processes through the EOB cycle, the payment will be received in the next payment cycle.

Prior Authorization

KY MCO and KY FFS support / prior authorization contacts

KY MCO — Program questions: KYMCOPBM@MedImpact.com; Pharmacy Help Desk: (800) 210-7628 (24/7); Prior Authorizations Phone: (844) 336-2676 (8:00 AM–7:00 PM EST, 7 days/week); Prior Auth Fax: (858) 357-2612; Pharmacy Portal: https://kyportal.medimpact.com/; BIN: 023880 / PCN: KYPROD1 / GROUP: KYM01
KY FFS — Program questions: KYMFFS@MedImpact.com; Pharmacy Help Desk: (877) 403-6034 (24/7); Prior Authorizations Phone: (877) 403-6034 (8:00 AM–7:00 PM EST, 7 days/week); Prior Auth Fax: (858) 357-2612; Pharmacy Portal: https://kyportal.medimpact.com/; BIN: 026309 / PCN: KYPROD1 / GROUP: KYF01

Benchmark Definitions

inv-05: National Average Drug Acquisition Cost (NADAC)

Update cadenceNADAC updates are posted to the CMS website weekly (every Wednesday) and incorporated into MedImpact systems the following Friday.

Relationship to compendiaDrug compendia (e.g., First Databank, Medi‑Span) ingest the weekly NADAC file and update their Medicaid pricing modules accordingly.

Effective dates/backdatingFor brand products, updated NADAC prices may be backdated to the effective date of the WAC or AWP increase as reflected in CMS/M&S files.

inv-06: WAC and AWP

DefinitionWholesale Acquisition Cost (WAC) and Average Wholesale Price (AWP) — manufacturer pricing benchmarks that commonly drive increases in NADAC for brand products.

Timing impactUpdated brand NADAC prices are typically reflective of increases in WAC and AWP from the previous week.

Reimbursement consequenceManufacturer increases in WAC/AWP can lead to updated NADAC values which may affect provider reimbursement for newly purchased inventory.