Following the unanimous passage last week of 21st Century Cures legislation by the House Energy and Commerce Committee, NACDS met with Committee staff this week to continue discussions on issues that affect pharmacy in the bill, which aims to foster healthcare innovation and solutions.
NACDS also reemphasized to the Committee that removing brands and generics from the calculation of FULs would cause pharmacies to be reimbursed at even lower rates…
Before the legislation passed last week, NACDS and allied stakeholders launched a concerted advocacy campaign to successfully prevent a provision on average manufacturer price (AMP)-based federal upper limits (FULs) from being included in the bill, which would have cost the industry an estimated $2 billion over the next ten years. The Committee had added the provision, along with other policy changes, to help fund the legislation.
In meeting with the Committee, NACDS underscored the importance of maintaining statutory authority for AMP-based FULs—especially in anticipation of possible changes to the Affordable Care Act (ACA) following an expected decision in the King v. Burwell Supreme Court case this summer. In addition, NACDS reiterated the need for at least a one-year implementation timeframe for states that need to be in compliance with the Centers for Medicare and Medicaid Services (CMS) final rule to implement AMP-based Medicaid pharmacy reimbursement as legislated by the ACA.
NACDS also reemphasized to the Committee that removing brands and generics from the calculation of FULs would cause pharmacies to be reimbursed at even lower rates, as a larger number of FULs fall below pharmacy acquisition rates. Decreasing pharmacy reimbursement for generic drugs could increase healthcare costs and negatively impact patient outcomes.
Removing the AMP-based FULs provision as an offset to pay for the 21st Century Cures legislation was a win for pharmacy, and NACDS will continue to focus on opposing an additional “pay-for” in the legislation, which would limit Medicaid reimbursement for durable medical equipment (DME) to the rates paid by Medicare.