Inpatient Pharmacy Charge Structure

FY 2010-2011

AWP Multipliers Current Proposed 7% ↑ Actual 0.01 to 25.00 4.53 4.97 9.70%

25.01 to 250.00 3.82 4.16 9.00%

250.01 to 750.00 3.06 3.37 10.10%

750.01 + 2.23 2.47 10.60%

Charge Formula Minimums Current Proposed 7% ↑ Actual CommentsUD/Bulk Meds (not otherwise listed) 7.25$ 7.75$ 6.9%

Relabel for Home Use 7.25$ 7.75$ 6.9%

Oral Syringes 14.00$ 15.00$ 7.1%

Inhalation Meds 14.00$ 15.00$ 7.1%

Compounded Topical Meds 28.00$ 30.00$ 7.1%

Heparin Lock Flush 71.00$ 76.00$ 7.0%

IV meds - vials or amps 82.00$ 88.00$ 7.3%

IV syringes - single ingredient 82.00$ 88.00$ 7.3%

Heparin Bag for OR 212.00$ 227.00$ 7.1%

Morphine PCAs 212.00$ 227.00$ 7.1%

IV syringes - multiple ingredients 212.00$ 227.00$ 7.1%

IV bags or bottles 212.00$ 227.00$ 7.1%

IV bags - custom concentrations 212.00$ 227.00$ 7.1%

Chemo syringe - single ingredient 256.00$ 274.00$ 7.0%

Chemo - multiple ingredients 351.00$ 376.00$ 7.1%

Dialysis 525.00$ 562.00$ 7.0%

TPN 1,425.00$ 1,525.00$ 7.0%

CRRT 850.00$ 910.00$ 7.1%

Botulism Immune Globulin 45,300.00$ 45,300.00$ 0.0%No change. Can only charge

cost of the drug to the patient

Each pharmacy charge is computed as follows: The AWP (average wholesale price--a

published figure) for the medication and quantity dispensed is multiplied by a number

which is on a sliding scale. The resulting figure is compared to the minimum charge

which is assigned to the type of drug dispensed, and the larger of the two figures is

selected.

Inpatient Pharmacy Charge Structure

FY 2010-2011

Sample Patient Charges -New Pharmacy Charge Formulas for fiscal year 05/06 through 09/10

FY 05/06 FY 06/07 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/12

% Increase

from prior

year

Acetaminophen 100 mg/ml 15ml Bottle $17.64 $19.05 $0.00 $0.00 $0.00 $0.00 $0.00 0.00%

Acetaminophen 500mg Tablet $5.00 $5.00 $0.00 $0.00 $0.00 $0.00 $0.00 0.00%

Acetylcysteine 100 mg/ml 4ml vial NA NA NA $25.22 $27.19 $29.36 $30.45 3.58%

Albuterol 0.5mg/0.5ml INH.NEB $10.00 $11.00 $12.00 $12.00 $13.00 $14.00 $15.00 6.67%

Alfentanil 500 mcg/ml 2ml Ampule $60.00 $65.00 $70.00 $70.00 $76.00 $82.00 $88.00 6.82%

Atropine 1% Ophth Oint 3.75gm Tube $18.64 $20.13 $22.14 $22.14 $13.82 $14.93 $16.34 8.63%

Bacitracin Ointment 15gm Tube $11.60 $12.53 $13.78 $13.78 $14.85 $16.04 $21.48 25.33%

Budesonide 0.25mg/2ml INH.NEB $21.36 $23.07 $26.89 $26.98 $31.56 $34.12 $36.83 7.36%

Deferoxamine 12gm/480ml NS $1,302.48 $1,406.68 $1,965.12 $1,965.12 $1,013.40 $1,094.25 $1,156.83 5.41%

Fat 20% Emulsion 360ml $176.40 $190.51 $209.16 $209.16 $208.73 $225.58 $242.89 7.13%

Filgrastim 75 mcg $208.25 $224.91 $262.10 $267.35 $325.00 $350.00 $375.70 6.84%

Gentamycin 40mg/ml 2ml Vial $60.00 $65.00 $70.00 $70.00 $76.00 $82.00 $88.00 6.82%

Humate-P 938 units $3,048.50 $3,292.38 $3,482.33 $3,482.33 $3,576.13 $3,938.33 $4,068.58 3.20%

Humalog 10ml vial $283.01 $305.65 $397.11 $420.73 $533.33 $576.38 $666.26 13.49%

Humalog 3ml vial NA NA NA NA NA $186.73 $199.90 6.59%

Leuprolide 15mg Kit $3,692.95 $3,988.39 $4,606.59 $4,882.98 $5,352.78 $5,668.68 $6,089.88 6.92%

Levalbuterol 0.63mg/3ml INH.NEB $12.52 $13.52 $17.62 $19.38 $23.96 $25.88 $27.93 7.34%

ElaMax 4% 5gm Tube $40.22 $43.44 $31.17 $29.21 $31.49 $34.01 $37.21 8.60%

Ondansetron 4mg Tablet $88.34 $95.41 $117.71 $117.71 $126.87 $137.03 $149.92 8.60%

Ondansetron 2mg/ml 2ml Vial $93.49 $100.96 $114.24 $70.00 $123.14 $133.00 $145.50 8.59%

Pentobarbital 50mg/ml 20ml Vial NA NA NA NA NA $2,414.24 $2,598.57 7.09%

Pentobarbital 50mg/ml 50ml Vial NA NA NA NA NA $3,582.39 $3,848.57 6.92%

MiraLax 17gm Packet $8.44 $9.12 $7.74 $7.79 $8.96 $9.68 $7.75 -24.90%

Rocuronium 10mg/ml 5ml Vial $66.56 $71.88 $85.79 $70.00 $76.00 $82.00 $88.00 6.82%

TPN $1,000.00 $1,100.00 $1,200.00 $1,200.00 $1,300.00 $1,425.00 $1,525.00 6.56%

Vincristine 2mg Dose $251.74 $277.28 $220.00 $220.00 $241.00 $256.00 $274.00 6.57%

Cytoxan/Mesna 1gm-300mg/150ml D5W $575.33 $629.91 $650.00 $503.64 $648.67 $712.53 $824.76 13.61%

Total Charges: $11,052.47 $11,970.82 $13,581.49 $13,705.52 $13,841.88 $21,124.16 $22,623.35 6.63%

FY 05/06 FY 06/07 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/12

Standard From Charge: Percent Percent Percent Percent Percent Percent Percent

Charge 0.01 300 332 375 375 412 453 497

Table 25.01 250 278 315 315 346 382 416

250.01 200 224 256 256 276 306 337

750.01 150 170 190 190 205 223 247

FY 05/06 FY 06/07 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/12

Formulas BIGIV $45,300.00 No Change No Change No Change No Change No Change No Change

Minimum CMPD $20.00 $22.00 $24.00 $24.00 $26.00 $28.00 $30.00

Patient CRRT NA NA NA NA $850.00 $850.00 $910.00

Charge CUSTOM $150.00 $160.00 $180.00 $180.00 $195.00 $212.00 $227.00

DIAL $360.00 $400.00 $450.00 $450.00 $486.00 $525.00 $562.00

HEPBAG $150.00 $160.00 $180.00 $180.00 $195.00 $212.00 $227.00

INH $10.00 $11.00 $12.00 $12.00 $13.00 $14.00 $15.00

INJ $60.00 $65.00 $70.00 $70.00 $76.00 $82.00 $88.00

IVPB $150.00 $160.00 $180.00 $180.00 $195.00 $212.00 $227.00

LVP $150.00 $160.00 $180.00 $180.00 $195.00 $212.00 $227.00

MED $5.00 No Change $6.00 $6.00 $6.50 $7.25 $7.75

MSPCA $150.00 $160.00 $180.00 $180.00 $195.00 $212.00 $227.00

OS $10.00 No Change $12.00 $12.00 $13.00 $14.00 $15.00

RELABEL $5.00 No Change $6.00 $6.00 $6.50 $7.25 $7.75

RX 25% 35% 50% 50% 54% 58% 58%

SYR $60.00 $65.00 $70.00 $70.00 $76.00 $82.00 $88.00

TPN $1,000.00 $1,100.00 $1,200.00 $1,200.00 $1,300.00 $1,425.00 $1,525.00

X $240.00 $260.00 $300.00 $300.00 $325.00 $351.00 $376.00

XM $180.00 $200.00 $220.00 $220.00 $237.00 $256.00 $274.00