How will the successful adoption of Maryland's fee schedule affect Arizona's current pricing structure?
Industry Leaders Watch Maryland's Acquisition Cost Model for Arizona Maryland has successfully implemented its first-ever workers’ compensation pharmacy fee schedule, which replaces list prices with acquisition cost. This model, based on the National Average Drug Acquisition Cost (NADAC) plus a reasonable dispensing fee, is now viewed as a new industry standard. Arizona is concurrently developing its own draft fee schedule language that mirrors this shift by tying topical reimbursement to a percentage of documented acquisition cost.
- Effect
- Mixed
- How direct
- 2 steps, all reported
- When
- Over the long term
- The story
- No new developments lately
How it reaches Arizona
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Regulators in Maryland approved average 14.6% premium increases for individual health insurance plans purchased through the state marketplace for 2027. This increase follows a 13.4% average increase approved for 2026. The premium hikes are needed as enhanced federal tax credits expired, which had helped keep costs down for consumers. About 274,000 Marylanders buy individual plans through the state’s Affordable Care Act marketplace.
The full event2independent outlets -
Maryland has introduced its first-ever workers’ compensation pharmacy fee schedule, which is based on an acquisition-cost index, such as the National Average Drug Acquisition Cost (NADAC). This schedule replaces the previous usual-and-customary-charge regime, which was criticized for allowing outlier bills.
1 report connects these two. Brind only summarizes; follow a link to read the reporting itself.
- workerscompensation.com Sunday
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state of the United States of America
Everything about Maryland -
This shift away from list-price benchmarks is seen as a necessary industry evolution. Arizona is currently working on its own draft fee schedule language that proposes shifting topical reimbursement to a percentage of documented acquisition cost, aligning with the industry trend set by Maryland.
1 report connects these two. Brind only summarizes; follow a link to read the reporting itself.
- workerscompensation.com Sunday
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state of the United States of America
Everything about Arizona
Tap any step to see the evidence behind it.
The facts so far
As reported. Each one links to where it comes from.
- Maryland's fee schedule is based on an acquisition-cost index, such as the National Average Drug Acquisition Cost (NADAC).workerscompensation.com
- The Maryland schedule replaces the usual-and-customary-charge regime.workerscompensation.com
- Arizona's draft fee schedule language shifts topical reimbursement to a percentage of documented acquisition cost.workerscompensation.com
Why it matters
For Arizona, the industry trend demonstrated by Maryland signals a necessary pivot away from outdated pricing models. The successful adoption of acquisition cost models in leading states like Maryland demonstrates the viability of this approach, putting pressure on Arizona to finalize its own draft fee schedule to remain competitive and fiscally responsible.
This move is part of a broader industry trend where regulators are learning that average wholesale price (AWP) is a list price, not a cost. By adopting acquisition cost as the basis for reimbursement, the industry is proactively addressing the issues that led to unsustainable outlier billing practices in the past.
What we don't know yet
- When will Arizona finalize its draft fee schedule language?
- How will the new acquisition cost model be implemented across all relevant services?
Is this still moving?
- Reports
- 2
- Developments
- 2
- Repetition
- 0%
What would change this answer
Reporting
- workerscompensation.comSunday
- baltimoresun.comSunday
Keep going
Brind's analysis is written by AI from the reporting linked above and can be wrong. It explains possible effects; it is not investment advice.