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Diane Publishing Books
Medicaid Prescription Drugs: CMS Should Implement Revised Upper Federal Limits and Monitor Their Relationship to Retail Pharmacy Acquisitions Costs
John E. Dicken (au)
States reimburse pharmacies for covered outpatient prescription drugs dispensed to Medicaid beneficiaries. For certain multiple-source outpatient prescription drugs, federal matching funds that states receive to reimburse pharmacies are limited by federal upper limits (FULs). In 2010, the Patient Protection and Affordable Care Act (PPACA) modified the FUL formula to better reflect pharmacy acquisition costs and thus more effectively control Medicaid expenditures. However, the Centers for Medicare & Medicaid Services (CMS) has not yet implemented the PPACA formula and continues to use FULs that were published in Sept. 2009. CMS currently publishes draft PPACA-based FULs. CMS also recently created the Nat. Average Drug Acquisition Costs (NADACs) for states to consider when setting reimbursement rates. This report (1) describes how CMS develops the NADACs and (2) examines how PPACA-based FULs compare to the NADACs. Tables and figures. This is a print on demand report.
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