Forty-nine congressmen have called on U.S. Health and Human Services Secretary Kathleen Sebelius to adopt a one-year transition period for states to implement the July 2014 average manufacturer price (AMP)-based federal upper limits (FULs) for Medicaid prescription drug reimbursement.


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Lawmakers: Transition time needed for final AMP-based FULs

April 22nd, 2014

ARLINGTON, Va. – Forty-nine congressmen have called on U.S. Health and Human Services Secretary Kathleen Sebelius to adopt a one-year transition period for states to implement the July 2014 average manufacturer price (AMP)-based federal upper limits (FULs) for Medicaid prescription drug reimbursement.

The National Association of Chain Drug Stores on Tuesday expressed support for the letter sent by the lawmakers to Sebelius and applauded Reps. Mike Rogers (R., Mich.) and Bruce Braley (D., Iowa) for leading the effort.

The Centers for Medicare & Medicaid Services (CMS) announced in November that it would publish the final AMP-based FULs this July and that those FULs should be used from that point on.

"We are greatly concerned that states are not prepared to make such a rapid transition considering that CMS expects states, by July 2014, to modify both drug reimbursement and possibly dispensing fees for Medicaid reimbursement," the congressmen said in the letter. "We urge CMS to permit states a transition period of one-year for implementation of the FULs as well as corresponding dispensing fee changes once they have the information they need to make these changes."

The lawmakers stressed in the letter that many states won't be able to implement the final FULs by July.

"Most states face numerous obstacles to such a quick implementation, including the need for legislative or regulatory changes, legislative sessions this year that do not allow for Medicaid reimbursement changes, the need for cost of dispensing fee studies to ensure accurate pharmacy reimbursement, and/or will have to file a State Plan Amendment to implement the new FULs," they explained.

The implementation of the final AMP-based FULs "poses great concern" for pharmacy patient care, according to NACDS president and chief executive officer Steve Anderson.

"We appreciate the recognition by House lawmakers of how this immediate reimbursement change could impact access to pharmacy services for low-income Americans," he said in a statement.

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