United States Health Information Knowledgebase


Basis Of Cost Determination

Name:Basis Of Cost Determination
Definition:Code indicating the method by which 'Ingredient Cost Submitted' (Field 409-D9) was calculated.
Type:Data Element
Registration Authority:National Council for Prescription Drug Programs
Source:National Council for Prescription Drug Programs
Values for: Basis Of Cost Determination
Value Value Meaning
00 Default
01 AWP (Average Wholesale Price) - A pricing benchmark for prescription drugs.
02 Local Wholesaler - A legitimate supplier from the surrounding area who resells drugs.
03 Direct - - Represents the manufacturer's published catalog or list price for any item to non-wholesalers. It does not represent actual transaction prices and does not include prompt pay or other discounts, rebates or reductions.
04 EAC (Estimated Acquisition Cost)-A formula-driven estimate of an entity's actual acquisition cost of a product, typically using as a percentage of AWP, derived by applying a discount to AWP. Various EAC methodologies may exist to estimate acquisition costs.
05 Acquisition - Used to indicate the provided ingredient cost is the actual cost as paid by the provider to the supplier for the specific item.
06 MAC (Maximum Allowable Cost) - Maximum reimbursable ingredient cost amount according to a payer's price list.
07 Usual & Customary - The pharmacy's price for the medication for a cash paying person on the day of dispensing.
08 340B /Disproportionate Share Pricing/Public Health Service - Price available under Section 340B of the Public Health Service Act of 1992 including sub-ceiling purchases authorized by Section 340B (a)(10) and those made through the Prime Vendor Program (Section 340B(a)(8)). Applicable only to submissions for Medicaid and other state or federal programs when required by law or regulation and when the payer and/or processor has communicated a unique RxBIN or unique RxBIN/RxPCN combination to distinguish these from other lines of business that do not meet the requirement.
09 Other - Different from those implied or specified.
10 ASP (Average Sales Price) - The average sales price (ASP) is a cost basis required by and reported to CMS for pricing Medicare Part B drugs.
11 AMP (Average Manufacturer Price) - The average price paid to manufacturers by wholesalers for drugs distributed to the retail class of trade; calculated net of chargebacks, discounts, rebates, and other benefits tied to the purchase of the drug product, regardless of whether these incentives are paid to the wholesaler or the retailer.
12 WAC (Wholesale Acquisition Cost) - A cost as defined in Title XIX, Section 1927 of the Social Security Act.
13 Special Patient Pricing - The cost calculated by the pharmacy for the drug for this special patient.
14 Cost basis on un-reportable quantities
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