The National Association of Chain Drug Stores has hailed the government’s postponement of final federal upper limits (FULs) for Medicaid prescription reimbursements based on average manufacturer price (AMP).


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CMS delays shift to new FULs

June 16th, 2014

ARLINGTON, Va. – The National Association of Chain Drug Stores has hailed the government’s postponement of final federal upper limits (FULs) for Medicaid prescription reimbursements based on average manufacturer price (AMP).

Final AMP-based FULs under the Affordable Care Act, which were to take effect in July, will be delayed to provide “sufficient time” for implementation, the Centers for Medicare and Medicaid Services (CMS) said this month. The new finalization date will be set after further detailed guidance on implementation is issued to states, the agency said.

Regulators acted on “the urging of state officials, federal legislators and pharmacy patient care advocates,” said NACDS president and chief executive officer Steve Anderson. “To ensure Medicaid beneficiaries’ access to pharmacy services, states need to update reimbursement for both the cost of dispensing and ingredients,” he said.

A coalition including NACDS in April called on the Department of Health and Human Services (HHS) to allow a one-year transition period for states to fully implement the AMP-based FULs. Other coalition members include the National Community Pharmacists Association, American Pharmacists Association, Food Marketing Institute, Generic Pharmaceutical Association, Healthcare Distribution Management Association and National Alliance of State Pharmacy Associations.

Anderson said NACDS looks forward to learning more about CMS’ upcoming guidance “and working together to create a reasonable transition period to help states fully implement FULs that create a fair and accurate reimbursement structure, and for the good of Medicaid beneficiaries.”

The announcement from CMS said it will continue to draft monthly Affordable Care Act FUL data, including the relationship of these FULs to National Average Drug Acquisition Cost pricing. “We will also continue to post the draft monthly Affordable Care Act FUL files on Medicaid.gov,” it said.

In seeking the postponement, NACDS met with CMS officials and contacted HHS and White House staff. In addition, the association made the need for an adequate transition period a focus of its RxImpact Day on Capitol Hill advocacy event in March and, along with members, had meetings at more than 400 congressional offices to discuss the issue. The meeting generated bipartisan letters supporting NACDS’ stand signed by 49 House members and nine ­senators.

The letter from the senators said that July implementation “will pose problems for under-reimbursement of Medicaid prescriptions at the state level, which may pose problems for beneficiaries. … Most states face numerous obstacles to immediate implementation, including current-year legislative sessions that do not allow for Medicaid reimbursement changes, the need for legislative or regulatory changes to achieve compliance, the need for cost-of-dispensing-fee studies for calculating fair pharmacy reimbursement, and/or the need to file a state plan amendment to implement the new reimbursement approach.”

Anderson thanked members of the Senate and House “who requested an adequate transition period so that states have the opportunity to make an effective transition.”

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