The National Association of Chain Drug Stores has issued comments to the Centers for Medicare & Medicaid Services (CMS) in the wake of the agency's issuance of a proposed rule on Sept. 3.


NACDS, National Association of Chain Drug Stores, Centers for Medicare & Medicaid Services, CMS, Medicaid, AMP, average manufacturer price, federal upper limits, FUL, multiple-source drugs, pharmacy, drug store, AMP rule, Medicaid, pharmacy reimbursement, Deficit Reduction Act of 2005, Medicaid reimbursement, community pharmacy, Patient Protection and Affordable Care Act, PPACA






























































































































































































































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NACDS gives take on CMS proposal to pull AMP provisions

October 5th, 2010

ALEXANDRIA, Va. – The National Association of Chain Drug Stores has issued comments to the Centers for Medicare & Medicaid Services (CMS) in the wake of the agency's issuance of a proposed rule on Sept. 3.

NACDS said CMS' action on Monday would withdraw two provisions of the July 17, 2007, rule related to pharmacy Medicaid reimbursement, a rule that has been blocked by an injunction following a lawsuit brought by NACDS and the National Community Pharmacists Association (NCPA).

In comments to CMS, NACDS on Tuesday commended the agency for issuing the proposed rule, which relates to the definition of average manufacturer price (AMP) and the calculation of federal upper limits (FUL) for multiple-source drugs.

"NACDS strongly believes the final AMP rule was fundamentally flawed and implemented the Medicaid pharmacy reimbursement provisions of the Deficit Reduction Act of 2005 in a manner that was inconsistent with congressional intent," the letter to CMS stated.

NACDS and the NCPA challenged the original final rule in federal court in the District of Columbia in 2007 and won an injunction, which prohibited implementation of the AMP rule, and subsequently has prevented $5.5 billion in Medicaid reimbursement cuts to pharmacies.

In the letter, NACDS expressed its commitment to work with CMS on regulations to implement the new health care reform law. "We offer these comments in the hopes of establishing a strong, collaborative partnership with the agency and the implementation of a Medicaid pharmacy reimbursement policy for multiple-source drugs that maintains the strong link between community pharmacies and Medicaid patients."

NACDS also called for CMS to redefine the terms "average manufacturer price," "retail community pharmacy" and "wholesaler" to ensure that implementation of the rule's provisions is consistent with congressional intent as set forth in the Patient Protection and Affordable Care Act (PPACA).

In addition, the association urged CMS to create future rulemaking that would make the FUL for multiple-source drugs no less than 175% of weighted AMP based on national sales utilization for all nationally equivalent multiple-source drug products.

"The 'no less than 175%' language of PPACA provides clear authorization to CMS to use a higher multiplier to determine FULs in all cases, or in specific instances," NACDS stated in its comments. "NACDS believes this is critical in ensuring pharmacies are not reimbursed at a level below their costs to purchase prescription drugs,"

Also, NACDS said it expressed support for the withdrawal of the multiple-source drug rule issued in 2008 to ensure consistency with PPACA.

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