The Centers for Medicare & Medicaid Services (CMS) should take steps to ensure that states increase dispensing fees for Medicaid drugs in conjunction with the new federal upper limits (FULs) that are anticipated in 2014, contend the National Association of Chain Drug Stores and the National Community Pharmacists Association (NCPA).


National Association of Chain Drug Stores, NACDS, National Community Pharmacists Association, NCPA, dispensing fees, Medicaid drugs, federal upper limits, FULs, pharmacy groups, Centers for Medicare & Medicaid Services, CMS, Carol Kelly, Steve Pfister, average manufacturer price, AMP, pharmacy reimbursement, pharmacy acquisition costs, retail pharmacy organizations, American Pharmacists Association, World Health Organization, WHO, naming biosimilars, individual nonproprietary name, INN, reference biologic










































































































































































































































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Industry groups weigh in on Medicaid, biosimilars

November 11th, 2013

ARLINGTON, Va. – The Centers for Medicare & Medicaid Services (CMS) should take steps to ensure that states increase dispensing fees for Medicaid drugs in conjunction with the new federal upper limits (FULs) that are anticipated in 2014, contend the National Association of Chain Drug Stores and the National Community Pharmacists Association (NCPA).

In a letter sent last month to CMS, the pharmacy groups reiterated their concerns about proposed reimbursement limits that they assert would not even cover pharmacy acquisition costs for hundreds of products. The letter was signed by NACDS senior vice president of government affairs and public policy Carol Kelly and NCPA senior vice president of government affairs and advocacy Steve Pfister.

NACDS and NCPA emphasized that the average manufacturer price (AMP) is an inaccurate benchmark for pharmacy reimbursement and that there is no correlation between the weighted AMP and pharmacy acquisition costs.

“In a number of instances, the AMP-based FUL is lower than the pharmacy’s acquisition cost for a given drug,” the groups stated in the letter. “In light of the looming problem of under- reimbursement, it is important for CMS to advocate to state Medicaid directors the importance of increasing dispensing fees to account for this problem. We urge CMS to make clear to states that in order to maintain patient access to pharmacies, dispensing fees must be increased to reflect no less than the true cost of dispensing prescription medications to Medicaid patients.”

NACDS and NCPA also warn that if states do not increase their dispensing fees, Medicaid patient access to pharmacy may be at risk.

“If states fail to increase Medicaid dispensing fees at the same time that AMP-based reimbursement is falling, then pharmacies may be forced to withdraw from the Medicaid program, denying patients access to Medicaid drugs,” the groups stated in the letter.

In another health care issue, the two retail pharmacy associations, as well as the American Pharmacists Association, dispatched a letter to the World Health Organization regarding the issue of naming biosimilars through an individual nonproprietary name (INN) qualifier. WHO has been asked to determine whether the system that has been used for small-molecule drugs — using the INN for both brand and generics — should be applied to biologics. The pharmacy organizations have maintained that biosimilars keep the same name as their reference biologic counterparts and not use suffixes.

“We continue to maintain this position and are concerned that the use of qualifiers for common active ingredients may generally increase confusion, leading to increased safety concerns and possibly medication errors, said the letter. An NDC code that pharmacies already use to track products can be used.”

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