Community pharmacy advocates say concerns by 40 members of Congress that proposed Medicaid reimbursement rates are inadequate could eventually lead to changes in the plan.


Community pharmacy, federal upper limits, FULs, pharmacy reimbursement, Medicaid reimbursement, National Association of Chain Drug Stores, NACDS, National Community Pharmacists Association, NCPA, Medicaid ­prescriptions, Bruce Braley, Mike Rogers, Centers for Medicare and Medicaid Services, CMS, Steve Anderson, Douglas Hoey, draft FUL lists, average manufacturers price, AMP, Congress, Richard Monks










































































































































































































































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Pharmacy gains momentum in FUL fight

January 2nd, 2012

ALEXANDRIA, Va. – Community pharmacy advocates say concerns by 40 members of Congress that proposed Medicaid reimbursement rates are inadequate could eventually lead to changes in the plan.

The National Association of Chain Drug Stores and National Community Pharmacists Association (NCPA) say that a letter sent by Rep. Bruce Braley (D., Iowa) and Mike Rogers (R., Mich.) and 38 of other lawmakers to the Centers for Medicare and Medicaid Services (CMS) cites problems with the federal upper limits (FULs) that are used to calculate reimbursements for Medicaid ­prescriptions.

“We are concerned that these lists contain flawed information that is not reliable for use in establishing pharmacy reimbursement in Medicaid,” the letter says. “We ask that you direct states not to use these draft lists for reimbursement purposes until they can be improved and finalized through a formal notice of proposed rule.”

The House members’ letter reiterates many of the same concerns that NACDS and NCPA have expressed with the draft FUL lists. “We are heartened that our arguments have been given further credibility by a large, bipartisan group of representatives,” NACDS president and chief executive officer Steve Anderson and NCPA CEO Douglas Hoey say.

Besides urging CMS to cease publication of draft FUL lists until a final average manufacturers price (AMP) rule is in place, the House members urged the agency to be mindful of comprehensive pharmacy reimbursement, noting that product cost and cost to dispense must be taken into consideration.

“When setting pharmacy reimbursement rates both components of reimbursement — product cost and cost to dispense — must be taken into consideration when determining whether pharmacies are paid adequately,” the members of Congress wrote.

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