Lawmakers Urge One-Year Transition Period on Implementation of Medicaid Reimbursement

Published Online: Tuesday, April 22, 2014
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Arlington, Va., April 22, 2014 – This week, 49 members of the U.S. House of Representatives urged Health and Human Services Secretary Kathleen Sebelius to adopt a one-year transition period for states to implement the July 2014 average manufacturer price (AMP)-based federal upper limits (FULs). The National Association of Chain Drug Stores (NACDS) commended Reps. Mike Rogers (R-MI) and Bruce Braley (D-IA) for leading the letter effort with their colleagues.

“We are greatly concerned that states are not prepared to make such a rapid transition considering that CMS expects states, by July 2014, to modify both drug reimbursement and possibly dispensing fees for Medicaid reimbursement,” the lawmakers stated in the letter. “We urge CMS to permit states a transition period of one-year for implementation of the FULs as well as corresponding dispensing fee changes once they have the information they need to make these changes.”

In the letter, the lawmakers emphasized the need for a transition period to help states meet the requirements of the final rule.

“Most states face numerous obstacles to such a quick implementation, including the need for legislative or regulatory changes, legislative sessions this year that do not allow for Medicaid reimbursement changes, the need for cost-of-dispensing-fee studies to ensure accurate pharmacy reimbursement, and/or will have to file a State Plan Amendment to implement the new FULs,” the letter stated.

NACDS President and CEO Steven C. Anderson, IOM, CAE expressed appreciation to lawmakers in signing this letter, “The implementation of these AMP-based FULs poses great concern for pharmacy patient care, and we appreciate the recognition by House lawmakers of how this immediate reimbursement change could impact access to pharmacy services for low-income Americans.”
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