Pharmacists Call for Delay on New Medicaid Generic Reimbursement Rates

Pharmacists and drug manufacturers are pushing the CMS for a one-year transition period before states attempt to implement a new formula mandated under the Patient Protection and Affordable Care Act that will significantly trim Medicaid reimbursement rates for generic drugs.

Pharmacists and drug manufacturers are pushing the CMS for a one-year transition period before states attempt to implement a new formula mandated under the Patient Protection and Affordable Care Act that will significantly trim Medicaid reimbursement rates for generic drugs.

Last August, HHS' Office of the Inspector General compared existing state Medicaid programs' generic prescription reimbursement limits with the new limits mandated by the ACA and found that on average, the new federal reimbursement limits are 22% below the current state amounts and could save Medicaid up to $1.2 billion per year.

In November, CMS notified states that they would be expected to implement the updates to the formula by July 2014. A coalition of industry stakeholders sent a letter April 9 to HHS Secretary Kathleen Sebelius, asking that there be a one-year transition period, which would push the implementation to sometime in 2015.

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Source: Modern Healthcare