CMS Delays Rule on Pharmacy Reimbursement for Prescription Drugs
- By BSTQ Staff
The Centers for Medicare and Medicaid Services (CMS) has delayed enforcement of a rule that changes the way state Medicaid agencies reimburse pharmacies for prescription drugs. While pharmacies requested a delay until October, CMS has instead delayed the enforcement date for inhalation, infusion, instilled, implanted or injectable drugs until July 2017. At that time, state Medicaid agencies will begin reimbursing pharmacies for prescription drugs based on acquisition costs. Previously, pharmacies were reimbursed based on the cost of the ingredients to make the drug plus a dispensing fee for filling the prescription.
Drugmakers requested delay of the rule so that they could determine the average manufacturer price (AMP) for that subset of drugs that are not generally dispensed through retail community pharmacies. CMS responded by giving manufacturers a “transition period” to make modifications and test their systems to calculate and report the AMP for drugs. According to CMS, the rule will save $2.7 billion over five years in state and federal costs, primarily because of alterations it made to the federal upper limit of drug reimbursements.
