A group of 40 congressmen have called on the Centers for Medicare & Medicaid Services (CMS) to stop publishing draft lists of federal upper limits (FULs) used for reimbursing pharmacies under Medicaid.


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Lawmakers to CMS: Don't publish draft FUL lists

December 16th, 2011

ALEXANDRIA, Va. – A group of 40 congressmen have called on the Centers for Medicare & Medicaid Services (CMS) to stop publishing draft lists of federal upper limits (FULs) used for reimbursing pharmacies under Medicaid.

The National Association of Chain Drug Stores and the National Community Pharmacists Association on Thursday applauded Reps. Bruce Braley (D., Iowa) and Mike Rogers (R., Mich.) and 38 other House members who signed a letter to CMS that expressed their concerns with draft FUL lists released by CMS.

In the letter, the lawmakers cited draft FUL lists published by CMS in Sept. 22, Oct. 21 and Nov. 18 that used average manufacturer price (AMP) as a basis for pharmacy reimbursement. They said they feared the publication of those lists "could damage Medicaid beneficiaries' access to retail pharmacies."

"We are concerned that these lists contain flawed information that is not reliable for use in establishing pharmacy reimbursement in Medicaid. We ask that you direct states not to use these draft lists for reimbursement purposes until they can be improved and finalized through a formal notice of proposed rule," the congressmen stated in the letter.

The lawmakers noted in their comments that "there is no regulatory process in place to direct drug manufacturers on how to report AMP or to govern how FULs are calculated. Therefore, we urge CMS to discontinue publishing draft FULs until a final AMP rule is in place."

NACDS expressed concern with the draft FUL lists in comments to CMS in October, when NCPA also sent a letter to the agency on the matter. In November, NCPA sent another letter to CMS after another draft FUL was published without any adjustments. 

"We are heartened that our arguments have been given further credibility by a large, bipartisan group of representatives," NACDS president and chief executive officer Steve Anderson and NCPA CEO B. Douglas Hoey said in a statement. "We want to especially thank representatives Braley and Rogers for their leadership on this important issue."

NACDS and NCPA also noted that in the letter the congressmen urged CMS to be aware of the elements of pharmacy reimbursement.

"When setting pharmacy reimbursement rates both components of reimbursement — product cost and cost to dispense — must be taken into consideration when determining whether pharmacies are paid adequately," the representatives wrote.

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