Pharmacy groups urge CMS to delay reimbursement-rate changes

April 10, 2014

A coalition that includes several pharmacy groups is asking Health and Human Services (HHS) Secretary Kathleen Sebelius to delay implementation of the Medicaid average manufacturer’s price (AMP)-based federal upper limits (FULs) for prescription medications.

A coalition that includes several pharmacy groups is asking Health and Human Services (HHS) Secretary Kathleen Sebelius to delay implementation of the Medicaid average manufacturer’s price (AMP)-based federal upper limits (FULs) for prescription medications.

The coalition, which sent a letter to Sebelius, includes the American Pharmacists Association, the Food Marketing Institute, the Generic Pharmaceutical Association, the Healthcare Distribution Management Association, the National Association of Chain Drug Stores, the National Alliance of State Pharmacy Associations, and the National Community Pharmacists Association.

“Given CMS’ expectation that states adjust both the drug reimbursement and dispensing fees for Medicaid reimbursement by July 2014, we are concerned that many states are not ready to make such a quick transition,” the letter stated. “Therefore we are requesting that [the Centers for Medicare & Medicaid Services, (CMS)] allow states a transition period for implementation of the FULs and corresponding dispensing fee changes to be one year from the time the states have everything they need for implementation from CMS.”

Last year, CMS announced final publication of the National Average Drug Acquisition Costs (NADACs) and said that the final AMP-based FULs would be published in July 2014. CMS also said the final AMP rule would be released in May 2014.

The coalition fears that the final rule release date may be delayed, which would not allow sufficient time for states to make necessary regulatory changes or legislative changes.

“While CMS may be ready to implement changes to the ingredient side of the formula immediately in July 2014, states face additional obstacles that hinder their ability to be so expedient. Most states require legislative or regulatory changes, have short legislative sessions this year that do not allow for Medicaid reimbursement changes, will have to do a cost-of-dispensing-fee study prior to implementing a dispensing fee change, and/or will have to file a State Plan Amendment to implement such a change,” the letter stated.