Nine senators have called on U.S. Department of Health & Human Services Secretary Kathleen Sebelius to consider the challenges that states will face when the Centers for Medicare & Medicaid Services (CMS) publishes its final federal upper limits (FULs) for Medicaid reimbursement based on average manufacturer price (AMP).


Medicaid reimbursement, federal upper limits, FULs, average manufacturer price, AMP, final AMP-based FULs, U.S. Department of Health & Human Services, Kathleen Sebelius, Centers for Medicare & Medicaid Services, CMS, HHS, National Association of Chain Drug Stores, NACDS, Steve Anderson, Medicaid prescription drug reimbursement, one-year transition period, Mark Warner, Johnny Isakson, Rob Portman, Al Franken, Tammy Baldwin, Tim Kaine, Chris Murphy, Jon Tester, Mark Pryor
































































































































































































































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Senators back Rx reimbursement transition period

May 21st, 2014

ARLINGTON, Va. – Nine senators have called on U.S. Department of Health & Human Services Secretary Kathleen Sebelius to consider the challenges that states will face when the Centers for Medicare & Medicaid Services (CMS) publishes its final federal upper limits (FULs) for Medicaid reimbursement based on average manufacturer price (AMP).

The National Association of Chain Drug Stores said Wednesday that in their letter to Sebelius, the senators cited the need for a one-year transition period for states to implement the final AMP-based FULs, due to be published in July.

CMS has indicated that it expects the new FULs to be effective immediately, noted NACDS, which has previously expressed its support for a one-year transition period.

"We believe that such a rapid implementation will pose problems for underreimbursement of Medicaid prescriptions at the state level, which may pose problems for beneficiaries," the senators wrote in their letter to Sebelius. "We encourage CMS to establish a one-year transition period for state implementation of the FULs, as well as for implementing any necessary dispensing fee changes by the states once the new FULs have been published along with any corresponding and necessary regulatory guidance."

Senators signing the letter include Mark Warner (D., Va.), Johnny Isakson (R., Ga.), Rob Portman (R., Ohio), Al Franken (D., Minn.), Tammy Baldwin (D., Wis.), Tim Kaine (D., Va.), Chris Murphy (D., N.Y.), Jon Tester (D., Mont.) and Mark Pryor (D., Ark.).

"Most states face numerous obstacles to immediate implementation," the senators noted, "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."

The letter also cites the support for a one-year transition period by the National Association of Medicaid Directors (NAMD). In a letter to CMS last September, NAMD also recognized obstacles for states and requested that CMS set a transition period of up to one year for implementation. 

NACDS voiced its support for senators' letter to HHS, stressing that states need more time to fully implement AMP-based FULs.

"The bottom line is that patient access to pharmacy care should not be compromised," NACDS president and chief executive officer Steve Anderson said in a statement. "Implementation of these AMP-based FULs poses great concern for pharmacy patient care, and we appreciate the leadership of Sens. Mark Warner and Johnny Isakson and the support of their colleagues in recognizing how this immediate reimbursement change could impact access to pharmacy services for low-income Americans."

The call for a one-year transition period already has drawn solid support in Congress. In late April, 49 House members sent a letter to Sebelius urging the adoption of a one-year transition period for states to implement the final AMP-based FULs for Medicaid prescription drug reimbursement.

Earlier that month, pharmacy trade groups were part of a coalition urging HHS to allow a one-year transition period for states to fully implement AMP-based FULs. Besides NACDS, the groups included 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. They noted that patient access to pharmacy services could be impacted if states don't have enough time to make the change.

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