5.7 Actual Acquisition Cost Policy
Last updated on August 12, 2025General Policy Description
For certain products, PharmaCare covers only the pharmacy’s actual cost of procuring the product.
Policy Details
For products subject to the Actual Acquisition Cost (AAC) policy, PharmaCare reimbursement will not exceed the provider’s AAC for the product up to a maximum price based on the manufacturer list price plus a 7% mark-up.
The product cost submitted in PharmaNet is to be reduced by any volume rebates or free goods received. Actual freight costs can be included in the AAC.
A discount paid or credited by a supplier for prompt payment of invoices is not included in the calculation of AAC. (The PharmaCare-recognized discount is usually no more than 2%.)
When submitting claims, the Drug Cost field should contain only the AAC. Charges in excess of the AAC must be entered in the Drug Upcharge field, these are not part of the claim value that is adjudicate.
PharmaCare will recover overpayments made as a result of claims submitted above the AAC.
Product costs submitted in excess of a PharmaCare maximum price will be adjudicated based on the applicable maximum price and any other applicable PharmaCare pricing policies.
Products subject to this policy, reimbursed at AAC up to the PharmaCare maximum price plus a dispensing fee (up to the PharmaCare maximum dispensing fee), include:
- Blood glucose test strips and continuous/flash glucose monitors
- Cystic fibrosis vitamin and nutritional supplements
Procedures
Entering claims under the AAC policy
Enter the AAC of the product in the PharmaNet Drug Cost field.
Enter any product cost in excess of the AAC in the Drug Upcharge field, not the Drug Cost field.
When entering a claim in PharmaNet, use the correct unit of measure. Refer to the Correct Quantities list or the PharmaCare Formulary Search.