Pharmacists livid and desperate over AMP rule

Pharmacists worry following the release of the final rule on Medicaid reimbursement for generics.

The clock is ticking. In less than five months, the Centers for Medicare & Medicaid Services will implement its average manufacturer price (AMP) reimbursement rule for Medicaid generic drugs. The rule establishes reimbursement for multisource drugs in the Medicaid program at 250% of the AMP.

It is how CMS interpreted key issues such as what constitutes retail pharmacy and which data should be included in its calculations that has upset pharmacy organizations. The Coalition for Community Pharmacy Action, formed by the National Community Pharmacists Association and the National Association of Chain Drug Stores, termed the rule "devastating," while the American Pharmacists Association stated it was "deeply concerned" about the rule's impact on pharmacists and patients.

As pharmacy organizations lobby Congress to change the rule, pharmacists around the country are beginning to react to its potential impact.


Other pharmacists, however, are only beginning to learn about AMP's potential impact. Tony Beraldi, R.Ph., of Oard Ross Drug Store in Council Bluffs, Iowa, who is president of the Southwest Iowa Pharmacists Association, said it has been difficult to get R.Ph.s actively engaged in the issue. "It's an education problem," he explained. "A lot of pharmacists have their heads buried in the sand."

Another Iowa R.Ph., Matt Osterhaus of rural Maquoketa, recently testified before the House Committee on Small Business that the new rule might force him and other small pharmacies out of the program. The Patient Access to Medicaid Generic Prescription Drugs Act of 2007, which aims to change several provisions in the AMP rule, was recently introduced in the House, but it is unclear when it will come up for a vote.

Pharmacist Jae Shin of Los Angeles has started a petition drive to express his frustration over the impact of the AMP rule, pharmacy benefit manager influence, and other issues confronting pharmacies. At press time, Shin has obtained more than 188 signatures. The petition can be reached at

Mathew Kopacki, owner of Rock Ridge Pharmacy in Glen Rock, N.J., has taken that educational message straight to the public. "The public knows the health system is broken, but they don't know what to fix," he noted. "Pharmacists need to explain in detail what to do."

Kopacki worries that R.Ph.s need to be able to speak with a single voice if they expect to help shape the healthcare debate. "We are our own enemy," he lamented. "Pharmacists must become organized as a group and see one another as colleagues, not competitors. We need to say, 'We're mad as hell, and we're not going to take this anymore.'"