Medicaid is a joint federal-state program that provides health coverage to certain categories of low-income persons including children, pregnant women, parents of eligible children, and persons with disabilities. One of its most important benefits is prescription drug coverage. Outpatient prescription drug coverage under Medicaid is an optional benefit; however all state Medicaid programs cuurently provide coverage for prescription drugs, although there are differences in state policies with regard to copays, types of drugs that are covered, and the number of prescriptions that can be filled. While Congress and the Centers for Medicare and Medicaid Services (CMS) set out the general rules under which Medicaid operates, each state runs its own program.

The Centers for Medicare & Medicaid Services (CMS) issued a 658-page, often-delayed, final rule on the use of Average Manufacturer Price (AMP) to calculate Federal Upper Limits (FULs) in determining reimbursement for generic drugs covered by fee-for-service Medicaid programs. FULs are calculated when there are at least three FDA-approved pharmaceutically and therapeutically equivalent multiple source drug products.

NCPA has been advocating on behalf of our members for over 10 years for a fair and equitable Medicaid pharmacy reimbursement system.

We are pleased to offer a summary of the top-line issues in the final rule that will impact independent community pharmacy.

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