NCPA to CMS: Medicaid reimbursements should adhere to healthcare-reform law provisions

ALEXANDRIA, Va. The National Community Pharmacists Association is urging the Centers for Medicare and Medicaid Services to follow guidance that Congress included in the healthcare-reform law in its implementation of a new Medicaid generic drug reimbursement formula based on average manufacturer price, the organization said Tuesday.

CMS recently withdrew provisions that would have dramatically cut Medicaid pharmacy reimbursement to community pharmacies from a previously proposed AMP rule due to an injunction that the NCPA obtained in 2007.

In a letter to Congress, the NCPA recommended giving manufacturers more direction in calculating their AMPs, such as requiring them to only include prices paid by wholesalers for drugs subsequently sold at pharmacies; recognizing the ill effect that the NCPA said curtailed generic drug reimbursements would have on retail pharmacies; and setting up a process by which revised federal upper limits resulting from the revised AMP data will be implemented in order to minimize disruption for patients and pharmacies.

“In many ways, independent community pharmacies are the backbone of Medicaid’s prescription drug benefit,” NCPA acting EVP and CEO Douglas Hoey said. “Pharmacies will become an even more important source of health care-related services for Medicaid beneficiaries as new healthcare reform provisions are implemented.”