On November 30, 2009, the U.S.
Government Accountability Office (GAO) released a report
http://r.listpilot.net/c/aphanet/4tswaz9/244d2 on the effect of
average manufacturer's price (AMP) reimbursement formula on Medicaid outpatient prescription drugs for the second quarter of 2008.
The purpose of this report was to compare the
federal upper limits (FULs) for reimbursement with average retail pharmacy acquisition costs. The GAO report found that
"if AMP-based FULs had been in place in the second quarter of 2008, they would have been lower than average retail pharmacy acquisition costs, in general".Specifically, the GAO found that for the second quarter of 2008:
* The median AMP-based FULs would have been lower than average retail pharmacy acquisition costs for
54 of the
83 drugs in the GAO sample;
*
44 drugs, from the GAO sample, had FULs that would have been at least
25% below acquisition costs;
* In the aggregate, the FULs would have been
17% lower than acquisition costs, though the difference varied significantly by state,
from 57% lower to 49% higher;
*
64 drugs had at least one therapeutically equivalent version with
acquisition costs below the FUL, indicating that pharmacies may be able to substitute lower-priced therapeutic equivalents to bring their costs
below the FUL;
* For
38 drugs, AMP-based FULs varied significantly throughout 2008, and in some cases
exceeding the average retail pharmacy acquisition cost one month and
falling below it in another month; and
* Variation occurred because manufacturers did not report AMP data each month for
11% of the therapeutically equivalent versions of the drugs in the GAO sample.
The
Centers for Medicare and Medicaid Services (CMS) provided written comments on the draft of this report, disagreeing with the report's findings and noting that:
* GAO's data source used to estimate average retail pharmacy acquisition costs did not take into account
discounts and
rebates that drug manufacturers may provide to retail pharmacies; and
* There were
methodology and inconsistencies between GAO findings and the findings of a
Health and Human Services (HHS) Office Inspector General (OIG) report (which was provided to the GAO by HHS but has
not been released to the public yet).
APhA (American Pharmaceutical Association) continues to work with
National Association of Chain Drugs Stores and the
National Community Pharmacists Association to ensure appropriate pharmacy reimbursement in the Medicaid program. In particular, both the
House and Senate health care reform bills include provisions to modify the AMP reimbursement formula, and while imperfect, we support the Senate's version of these provisions.
APhA's complete comments to the House and Senate Leadership on merging the health care reform bills
http://r.listpilot.net/c/aphanet/4tswaz9/244ti are available.
Pro Pharma will provide updates on any new developments.
Craig S. Stern, PharmD, MBA
President
Pro Pharma Pharmaceutical Consultants, Inc.
