Shelving its earlier plan, the Centers for Medicare & Medicaid Services (CMS) reported that next month it won't be finalizing the Affordable Care Act federal upper limits (FULs) for Medicaid reimbursement based on average manufacturer price (AMP).


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CMS postpones final AMP-based FULs

June 2nd, 2014

ARLINGTON, Va. – Shelving its earlier plan, the Centers for Medicare & Medicaid Services (CMS) reported that next month it won't be finalizing the Affordable Care Act federal upper limits (FULs) for Medicaid reimbursement based on average manufacturer price (AMP).

CMS had previously announced in a Center for Medicaid and CHIP Services (CMCS) informational bulletin issued last fall that it planned to implement final AMP-based FULs in July.

"In the November 2013 informational bulletin, we stated that further detailed guidance would be provided for states to implement the Affordable Care Act FULs, and we remain committed to ensuring that this guidance is provided to states with sufficient time to implement the FULs," CMS stated.

"We expect to provide a new finalization date for the FULs when we release this subsequent guidance to states. We will continue to analyze the draft monthly Affordable Care Act FUL data, including the relationship of these FULs to the National Average Drug Acquisition Cost pricing, as we continue to work to implement the FUL provisions of section 1927(e)(4) of the Social Security Act," the agency said. "We will also continue to post the draft monthly Affordable Care Act FUL files on Medicaid.gov."

The National Association of Chain Drug Stores on Monday applauded the move. NACDS was part of a coalition that in April called on the U.S Department of Health and Human Services (HHS) to allow a one-year transition period for states to fully implement the AMP-based FULs for prescription drug reimbursement under Medicaid.

Others in the coalition 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.

"We are pleased that leaders at the Department of Health and Human Services and the Centers for Medicare & Medicaid Services have acted on the urging of state officials, federal legislators and pharmacy patient care advocates and announced the new timing. To ensure Medicaid beneficiaries' access to pharmacy services, states need to update reimbursement for both the cost of dispensing and ingredients," Steve Anderson, president and chief executive officer of NACDS, said in a statement.

"In its announcement, CMS cited that 'further detailed guidance would be provided for states to implement the Affordable Care Act FULs, and we remain committed to ensuring that this guidance is provided to states with sufficient time to implement the FULs,' " Anderson added. "We look forward to learning more from CMS about this 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."

NACDS said that after CMS released the bulletin on Nov. 27, the association met with the agency's staff and contacted HHS and White House staff with its concerns. In addition, NACDS 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, met with more than 400 Congressional offices to discuss the issue. The association, too, coordinated its advocacy effort with the National Association of Medicaid Directors and the AMP coalition of industry partners.

The push for the one-year transition period gained solid support in Congress. In April and May, respectively, 49 House members and nine senators sent letters to HHS Secretary Kathleen Sebelius urging her to consider the challenges that states would face if CMS published its final AMP-based FULs in July.

"NACDS appreciates members of the U.S. Senate and House of Representatives who requested an adequate transition period so that states have the opportunity to make an effective transition," Anderson stated.

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