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Lawmakers back transition period for AMP-based FULs

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ARLINGTON, Va. — The National Association of Chain Drug Stores has applauded the efforts of several members of Congress to obtain a transition period for new federal upper limits (FULs) in Medicaid reimbursement.

NACDS said Monday that in letters sent late last week, 64 members of the Senate and the House of Representatives urged Health and Human Services Secretary Sylvia Mathews Burwell to adopt at least a one-year transition period for states to implement the April 2015 average manufacturer price-based FULs. The letter effort was led by Sens. Johnny Isakson (R., Ga.) and Mark Warner (D., Va.) and Reps. Chris Collins (R., N.Y.) and Dave Loebsack (D., Iowa).

“The implementation of these AMP-based FULs poses great concern for pharmacy patient care,” NACDS president and chief executive officer Steve Anderson said in a statement. “And we appreciate the recognition by U.S. senators and representatives of the need for an adequate transition period so that states have an opportunity to make an effective transition to help preserve access to pharmacy services for low-income Americans.”

In the Senate letter, lawmakers called on the Centers for Medicare & Medicaid Services (CMS) to help preserve access to prescription medications for Medicaid patients by supporting “proper and accurate reimbursement for retail community pharmacies that dispense prescription drugs to Medicaid beneficiaries, and ensuring that state Medicaid programs have sufficient time to implement federal regulatory changes.”

Last June, CMS announced a delayed in the implementation of AMP-based FULs. Then in November, CMS stated that at the same time the “Final Rule on Medicaid Covered Outpatient Drugs” is released — expected in the near future, NACDS said — CMS aims to finalize the new FULs and guidance to states for implementing those FULs.

Given CMS’ upcoming regulatory action, the lawmakers stressed the need for at least a one-year transition period to help states meet the requirements of the final rule.

“States need time to pass drug reimbursement changes through their legislatures, particularly in light of the fact that a number of state legislatures end their sessions in spring or early summer every year,” the House letter said. “States will also need sufficient time to conduct cost-of-dispensing studies to allow for the calculation of fair pharmacy reimbursement, as well as time needed to file State Plan Amendments to make adjustments in light of the new FULs.”

The letters also cited the importance for CMS to engage with retail pharmacies and other stakeholders so that Medicaid enrollees’ access to the medications they need won’t be disrupted.


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