Leading pharmacy groups said 16 members of Congress are calling on House Speaker Nancy Pelosi to consider a higher federal upper limit (FUL) for reimbursing pharmacies for dispensing generic prescription drugs under the Medicaid program.


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Lawmakers urge higher FUL for Medicaid Rx

December 17th, 2009

ALEXANDRIA, Va. – Leading pharmacy groups said 16 members of Congress are calling on House Speaker Nancy Pelosi to consider a higher federal upper limit (FUL) for reimbursing pharmacies for dispensing generic prescription drugs under the Medicaid program.

The National Association of Chain Drug Stores and the National Community Pharmacists Association said Thursday that the lawmakers sent a letter to Pelosi (D., Calif.) pointing out that provisions in health care reform legislation would not adequately reimburse pharmacies for Medicaid prescriptions.

Acting as the Congressional Community Pharmacy Coalition, the congressmen write that, although House and Senate health reform bills include provisions scaling back the severe cuts written in to statute (but delayed by court injunction), "we are still concerned that the reimbursement levels proposed will not be sufficient to assure that Medicaid patients will be able to obtain prescription medications through their community pharmacies. This could reduce Medicaid patients' access to many pharmacies and negatively impact generic dispensing."

"We respectfully urge you to consider a higher FUL reimbursement rate for generics for pharmacies," during the expected House-Senate negotiations, the letter stated. "Community pharmacies play a critical role as primary health care providers in all communities across the United States and often serve as the only resource to millions of lower income Americans for their daily needs. Failure to adequately fix the Medicaid pharmacy reimbursement would directly impact these patients and the pharmacies that continue to serve them."

The letter explained that H.R. 3692, the Affordable Health Care for America Act, sets the new reimbursement limit for generics at 130% of the weighted average manufacturer price (AMP), and the Senate proposes to set reimbursement at no less than 175% of the weighted AMP. In addition, the lawmakers point out in the letter that in the previous Congress, the Fair Medicaid Drug Payment Act of 2007 (H.R. 3700) would have set the generics reimbursement rate at 300% of a multiple-source product's weighted AMP.

The letter was signed by Reps. Michael Arcuri (D., N.Y.), Joe Barton (R., Texas), Marion Berry (D., Ark.), Sanford Bishop (D., Ga.), Leonard Boswell (D., Iowa), Rick Boucher (D., Va.), Christopher Carney (D., Pa.), Joe Courtney (D., Conn.), Lloyd Doggett (D., Texas), Walter Jones (R., N.C.), Jerry Moran (R., Kan.), Cathy McMorris Rodgers (R., Wash.), Stephanie Herseth Sandlin (D., S.D.), Timothy Walz (D., Minn.), Anthony Weiner (D., N.Y.) and Peter Welch (D., Vt.).

"We are pleased that these members of Congress are working on behalf of pharmacy to ensure that Medicaid patients have access to their prescription drugs and other pharmacy services," NACDS president and chief executive officer Steve Anderson said in a statememt. "These patients should not be penalized due to an unfair reimbursement model."

NCPA executive vice president and CEO Bruce Roberts commented, "NCPA sincerely appreciates this bipartisan show of support for community pharmacy. Clearly, lawmakers across the political spectrum recognize the important role community pharmacists play in helping Medicaid recipients — and want to continue to play. But for that to happen, Congress must replace these deep cuts with an equitable reimbursement system."

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