Inside Health Policy reports that pharmacy stakeholders and states are watching for the Centers for Medicare & Medicaid Services (CMS) to finalize the Medicaid Average Manufacturer Price-based Federal Upper Limits this year, after the agency said in November it would release the final FULs around the same time as the Medicaid Covered Outpatient Drug final rule.
CMS is required by the Affordable Care Act to recalculate the FUL amounts and the agency had planned to finalize the FULs last July.
NACDS and a coalition of stakeholders, recognizing that the time between the proposed issuance of the final rule and the implementation of AMP-based FULs would not give states sufficient time to effectively comply, approached CMS early last year urging the agency to implement a transition period. Following up on the in-person advocacy, a bipartisan group of 49 House members and nine Senators wrote letters to Health and Human Services Secretary Kathleen Sebelius urging her to implement the transition period.
CMS released a bulletin in June 2014 announcing that it would not implement AMP-based Federal Upper Limits (FULs) in July, and that it would work to finalize guidance on the implementation of the FULs.
NACDS will monitor the final FULs when they are released to make sure they are consistent with the statute and that states will have enough time to implement the new pricing.