ARLINGTON, Va. — The Centers for Medicare and Medicaid Services has announced new timing to implement the Medicaid average manufacturer price-based federal upper limits for prescription medications, a move that has been applauded by the National Association of Chain Drug Stores. The FULs were expected to be finalized in July.
NACDS president and CEO Steve Anderson has issued a statement that reads:
“We are pleased that leaders at the Department of Health and Human Services and the Centers for Medicare and Medicaid Services have acted on the urging of state officials, federal legislators and pharmacy patient care advocates and announced the new timing. To ensure Medicaid beneficiaries’ access to pharmacy services, states need to update reimbursement for both the cost of dispensing and ingredients.
“NACDS also appreciates members of the U.S. Senate and House of Representatives who requested an adequate transition period so that states have the opportunity to make an effective transition.
“In its announcement, CMS cited that ‘further detailed guidance would be provided for states to implement the Affordable Care Act FULs, and we remain committed to ensuring that this guidance is provided to states with sufficient time to implement the FULs.’
“We look forward to learning more from CMS about this guidance and working together to create a reasonable transition period to help states fully implement FULs that create a fair and accurate reimbursement structure, and for the good of Medicaid beneficiaries.”
The full text of CMS’ announcement reads as follows:
This is to notify states and stakeholders that we will not be finalizing the Affordable Care Act Federal Upper Limits (FULs) in July 2014, as we previously announced in the Center for Medicaid and CHIP Services (CMCS) Informational Bulletin issued on November 27, 2013.
In the November 2013 Informational Bulletin, we stated that further detailed guidance would be provided for states to implement the Affordable Care Act FULs, and we remain committed to ensuring that this guidance is provided to states with sufficient time to implement the FULs. We expect to provide a new finalization date for the FULs when we release this subsequent guidance to states. We will continue to analyze the draft monthly Affordable Care Act FUL data, including the relationship of these FULs to the National Average Drug Acquisition Cost pricing, as we continue to work to implement the FUL provisions of section 1927(e)(4) of the Social Security Act. We will also continue to post the draft monthly Affordable Care Act FUL files on Medicaid.gov.
NACDS stated that it first heard about the July deadline in the November 27, 2013 informational bulletin from CMS that was released to states and stakeholders. Since that time, NACDS has engaged in a series of steps, including meeting with CMS staff on numerous occasions and also contacting Health and Human Services and White House staff with its concerns.
NACDS made an adequate transition period a focus of its NACDS RxIMPACT Day in March and, with its members, met with more than 400 Congressional offices to discuss the issue. Out of those meetings, NACDS was able to generate bipartisan letters signed by 49 Members of the House of Representatives and nine Senators, agreeing with NACDS’ position.
Following up on the letters, NACDS also asked members of Congress, Senators, and their staffs to call CMS personally to voice their concerns.