New Limits on Medicaid Generic Drug Reimbursement Proposed; Same Inadequate Result

By Kevin Schweers

Earlier this month the Centers for Medicare & Medicaid Services issued its fifth set of proposed Medicaid federal upper limits (FULs) for generic drug reimbursement, but it’s no better than its four predecessors for patients and their community pharmacists, NCPA recently wrote to the agency.

NCPA’s analysis of the list found “serious shortcomings that would result in devastating economic consequences for small business community pharmacies that serve Medicaid patients.” The NCPA letter to CMS also points out that, for hundreds of common, multi-source generic drugs, the latest proposed caps, or FULs, are lower than independent pharmacies’ current, market-based acquisition costs.

“If this set of FULs is implemented, it could result in the loss of access to community pharmacies for Medicaid patients,” NCPA wrote. “This could result in negative health consequences and sharply increased Medicaid costs for other health interventions if Medicaid patients cannot obtain their prescription medications.”

The letter renews NCPA’s call for CMS to refrain from publishing additional FULs or from implementing them until a final rule can be put in place governing how manufacturers calculate their average manufacturer prices (AMPs), on which the FULs are based.  In addition, NCPA reiterated a number of points made in its previous letters to CMS, including the fact that most states set reimbursement below the federal reimbursement limits (worsening the impact of inadequate FULs)

Click here to read a copy of NCPA’s letter.

2 Responses to “New Limits on Medicaid Generic Drug Reimbursement Proposed; Same Inadequate Result”

  1. 1 kathy rothrock February 25, 2012 at 3:27 am

    I am SO FRUSTRATED, and TIRED of fighting! I THOUGHT it was ILLEGAL to sell below cost, so how do CMS and the PBMs, PAY us below cost??? What other profession, business, would put up with this kind of crap? NO OTHER BUSINESS PUTS UP WITH THIS !!! Nobody works themselves to death to lose money, then go out of business- nobody, except pharmacists. Maybe we are just crazy.

  2. 2 Van G. Coble Dph, CDM, FASCP February 27, 2012 at 4:38 am

    Until all pharmacists can agree on a real cost basis, we will continue with this insane debate! This real cost basis must be in conjunction with a real dispensing fee. A real cost basis would negate the need for MACs, FULs, and whatever other acronyms that apply.

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