CMS-10241 National Average Drug Acquisition Cost (NADAC) Survey Re

Center for Medicaid and CHIP Services

National Average Drug Acquisition Cost (NADAC)
Survey Request for Information
March 1, 2021
Your pharmacy has been randomly selected for a sampling of invoices. We are requesting your
pharmacy provide the following information within 14 days:
1) Copies of all wholesaler, distributor, or manufacturer invoices, reflecting all brand, generic and
OTC drug purchases transacted with all your wholesale supplier(s) and/or drug manufacturer(s)
between
February 1, 2021 through February 28, 2021
2) Enclosed Cover Sheet (on gold-colored paper), if identifying submitted information as proprietary
and confidential
These records are to be limited to drug ingredient costs only. All costs that are not drug ingredient
costs, such as those for shipping, storage, warehousing, or other administrative costs or other internal
mark-ups, will not be considered when calculating the NADAC. For purposes of this survey, drug
ingredient costs should represent the invoice price paid by your pharmacy to an unrelated third party
supplier of outpatient drugs, such as your wholesaler or drug manufacturer. Drug ingredient costs
charged to your pharmacy by related parties that also include administrative costs or other mark-ups will
not be included in the NADAC calculations. Please do not submit any patient-identifiable information.
Information should be submitted in printed or electronic format and should include the following
information:
1)
2)
3)
4)
5)

National Drug Code (NDC)
Purchase price of drug (drug ingredient cost only – see instructions above)
Quantity purchased
Purchase date for each product
“Item number”-to-NDC crosswalk, if item numbers or other proprietary nomenclature is used on
your invoices.

As a time-saving alternative to you or your pharmacy staff submitting invoice records, you may contact
your drug supplier(s) to request and authorize them to forward an electronic or hard copy of your
purchasing history (as described above) for the requested period directly to Myers and Stauffer LC.
Please do not include any invoices that include Public Health Services 340B drug pricing.
Over

March 1, 2021
Page 2
Information should be mailed, faxed, or sent electronically to the following address within 14 days:
Myers and Stauffer LC
Attention: CMS Pharmacy Survey
800 East 96th Street, Suite 200
Indianapolis, IN 46240
OR
844-860-0236 FAX
OR
[email protected] (Please indicate “CMS Pharmacy Survey – confidential and proprietary” in
the subject line.)

*** PLEASE USE THE ENCLOSED COVER SHEET (ON GOLD-COLORED PAPER)
WHEN SUBMITTING YOUR PHARMACY’S INFORMATION TO IDENTIFY THIS
INFORMATION AS PROPRIETARY. FAILURE TO DO SO MAY MEAN IT WILL
NOT BE CONSIDERED PROPRIETARY.
Please be aware that information submitted will not be returned, therefore, please submit copies or
electronic files of these records. Your participation in this endeavor is strongly encouraged and greatly
appreciated. Please contact the Help Desk operated by Myers and Stauffer LC at (855) 457-5264 should
you have any questions.  

PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this
information collection is 0938-1041 (Expires: TBD). The time required to complete this information
collection is estimated to average 30 minutes per response, including the time to review instructions,
search existing data resources, gather the data needed, and complete and review the information
collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for
improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance
Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.