This morning, the House Energy and Commerce Committee unanimously passed 21st Century Cures legislation, the goal of which is to foster healthcare innovation. As the Committee considered provisions to help pay for the legislation, two concepts of consequence to pharmacy emerged.
NACDS and allied organizations advocated successfully for the elimination of one “pay-for” that threatened pharmacy patient care, while efforts to defend against the other “pay-for” will need to continue.
The provision that was kept out of the legislation approved by the Committee would have excluded brand and authorized generic drugs from the calculation of average manufacturer price (AMP), thereby calculating federal upper limits (FUL) for pharmacy Medicaid reimbursement based only on generic drug prices. This would have reduced pharmacy Medicaid reimbursement to inadequate levels – below pharmacy acquisition costs.
The provision was floated even as all eyes are on the Centers for Medicare & Medicaid Services in anticipation of a final rule to implement AMP-based Medicaid pharmacy reimbursement as legislated in the Affordable Care Act.
Amid the successful blocking of the drug-related “pay-for,” efforts will need to remain focused on battling an additional “pay-for” related to durable medical equipment (DME). The Committee approved a move to limit Medicaid reimbursement for DME to the rates paid by Medicare.
NACDS, the National Community Pharmacists Association and the American Pharmacists Association wrote to Committee Chairman Fred Upton (R-MI) and Ranking Member Frank Pallone (D-NJ) to articulate the patient-care concerns related to both provisions.