Wolters Kluwer Drug Pricing

October 17th, 2018 - Find-A-Code
Categories:   Drugs|Pharmaceuticals|FDA   Audits/Auditing   Practice Management   Medicaid   Medicare  
0 Votes - Sign in to vote or comment.

Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP).

Average Wholesale Price (AWP)

In the United States, the average wholesale price (AWP) is a pharmaceutical term that describes the average price paid by a retailer to buy a drug from the wholesaler. The AWP may be determined by several different methods.

  • The drug manufacturer may report the AWP to the individual publisher of drug pricing data
  • The AWP may also be calculated by the publisher based upon a mark-up specified by the manufacturer that is applied to the wholesale acquisition cost (WAC) or direct price (DP).
  • The wholesale acquisition cost (WAC) is the manufacturer’s list price of the drug when sold to the wholesaler. Pharmacies typically buy their drugs from wholesalers. WAC is the most common benchmark used today by pharmacies to buy drugs from wholesalers.
  • Typically a 20% mark-up is applied to the manufacturer-supplied WAC or DP, which results in the AWP.

Wholesale Acquisition Cost (WAC)

The wholesale acquisition cost (WAC) is an estimate of the manufacturer's list price for a drug to wholesalers or direct purchasers. WAC does not always represent the sales price in a single transaction accurately, as the manufacturer can choose to offer discounts or rebates that lower the price of which the product is sold to the wholesaler. 

Direct Price (DP)

Direct Price is the price at which non-wholesalers and providers can purchase drug products from a manufacturer. These prices can vary by transaction, as the manufacturer may offer discounts or rebates.

Manufacturer's Suggested Wholesale Price (SWP)

SWP is the reported price from the manufacturer for its drugs to be sold by wholesalers to customers. This does not reflect the pricing from the manufacturer to the customers. Wholesalers will determine the actual price of the product based on competitive and market factors.

Federal Upper Limit (CMS FUL)

The list of covered drug products comes directly from CMS and is updated periodically. They establish ceiling prices for each set of therapeutically equivalent drug products according to the formula in the Medicaid final regulation published July 31, 1987, by CMS' parent organization, the Department of Health and Human Services (HHS). The rule's reimbursement ceiling is set at 150% of the lowest published price for therapeutically equivalent drug products.

Average Wholesale Price (AAWP) & Generic Equivalent Average Price (GEAP)

The AAWP is a Wolters Kluwer Clinical Drug Information drug pricing concept. Generally, the AAWP represents the average of all AWPs for each multi-source drug product. The AAWP is not calculated when the number of manufacturers supplying a generic is insufficient. 

The Generic Equivalent Average Price (GEAP) is a Wolters Kluwer Clinical Drug Information drug pricing concept. The GEAP is not calculated when the number of manufacturers supplying a generic is insufficient. The GEAP is a generic price applied to all drug products sharing the same GPPC; however, all drug products with the same GPPC have not been used in the determination of the GEAP. 

To learn more, click here

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Proposed Risk Adjustment Changes
June 4th, 2020 - Wyn Staheli, Director of Research
On June 2, 2020, HHS published two proposed changes to the Risk Adjustment Data Validation (RADV) protocols for HHS-Operated Risk Adjustment Programs.
Watch for Payer Telehealth Coverage Changes
June 3rd, 2020 - Wyn Staheli, Director of Research
As our country moves forward with a phased approach to reopening, be sure to pay close attention to individual payer policies regarding how long these changes will remain in effect. Keep in mind that private payer, federal programs (Medicare, Medicaid), and Medicare Advantage plans can all have different timelines as well as different coverage.
Changes in Medicare Advantage and Part D
June 2nd, 2020 - Christine Taxin
The Centers for Medicare & Medicaid Services finalized several changes in Medicare Advantage and Part D on Friday. The Trump administration has finalized several changes in Medicare Advantage (MA) and Part D in anticipation of bid submissions on June 1. The Centers for Medicare & Medicaid Services (CMS) released Friday that includes ...
Additional Practice Reopening Tips
June 1st, 2020 - Wyn Staheli, Director of Research
As practices begin reopening across the nation, there are several things that need to be considered. Policies and Procedures Manuals need to be updated, malpractice carriers need to be contacted and everyone needs to consider mental health screenings and support.
Where is the CCI Edit with Modifier 25 on E/M?
May 20th, 2020 - Christine Woolstenhulme, QCC, CMCS, CPC, CMRS
If you are not seeing a CCI edit when reporting an E/M code with a certain procedure, it may be that there is no edit. CMS does not have a CCI edit for every CPT code, however, there are still general coding rules that must be followed.  The use of Modifier 25 is one example ...
Packaging and Units for Billing Drugs
May 18th, 2020 - Christine Woolstenhulme, QCC, CMCS, CPC, CMRS
To determine the dosage, size, doses per package and how many billing units are in each package, refer to the NDC number. Take a look at the following J1071 - Injection, testosterone cypionate, 1mg For example; using NCD # 0009-0085-10 there are 10 doses of 100 mL (100 mg/mL = 1 mL and there are ...
Getting Your Practice Back on Track
May 12th, 2020 - Wyn Staheli, Director of Research
As we begin returning back to work, we will all face a new normal. The COVID-19 pandemic has changed the face of business. While it has certainly been a challenge to keep up with the ever-changing regulations (that’s likely to continue for a little longer), exciting new opportunities have also been created, such as the expansion of telemedicine. There’s also the maze of government funding that needs to be navigated and an increased awareness of OSHA standards to implement.



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2020 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association