The National Association of Chain Drug Stores and the National Community Pharmacists Association have called on the Centers for Medicare & Medicaid Services (CMS) to assess "the true cost" of dispensing prescription drugs with the coming expansion of Medicaid services under the Affordable Care Act (ACA).


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NACDS, NCPA urge CMS to raise dispensing fees

October 24th, 2013

ARLINGTON, Va. – The National Association of Chain Drug Stores and the National Community Pharmacists Association have called on the Centers for Medicare & Medicaid Services (CMS) to assess "the true cost" of dispensing prescription drugs with the coming expansion of Medicaid services under the Affordable Care Act (ACA).

In a joint announcement Thursday, NACDS and NCPA said they sent a letter to CMS this week urging the agency to ensure that states raise dispensing fees for Medicaid prescriptions in tandem with the new federal upper limits (FULs) expected in 2014.

CMS is currently determining new Medicaid FULs that would apply to pharmacy reimbursement for many common generic drugs, NACDS and NCPA said. The associations noted that they have voiced concern about the reimbursement limits proposed thus far by CMS because they wouldn't cover a pharmacy's acquisition costs for hundreds of products.

In the letter, NACDS and NCPA explained that average manufacturer price (AMP) is an inaccurate benchmark for pharmacy reimbursement, and there's 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 two pharmacy 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."

Based on in-house calculations, NACDS and NCPA said that, on average, states would need to increase dispensing fees by $4.45 to offset the pharmacy reimbursement decrease under the new AMP-based FULs. The groups noted that if states don't raise dispensing fees, it may impact Medicaid patient access to pharmacy services.

"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 associations said.

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