Pharmacists nationwide are "bracing" for the July 2 release of a final rule by CMS that likely will reduce Medicaid reimbursements to pharmacies for generic prescription drugs, the Newark Star-Ledger reports (Cohen, Newark Star-Ledger, 6/24). The rule, mandated by the Deficit Reduction Act of 2005 and scheduled to take effect on Dec. 30, seeks to ensure that Medicaid can obtain prescription drug discounts similar to those obtained by private entities, such as pharmacy benefit managers.
Under the rule, pharmaceutical companies would have to offer Medicaid the lowest price offered to any purchaser -- which includes any "rebates, discounts or other price concessions" offered to PBMs or mail-order pharmacies. The rule also would redefine "average manufacturer price" for brand-name and generic prescription drugs. States use average manufacturer prices to calculate Medicaid reimbursement rates for prescription drugs. According to the rule, the federal government would post average manufacturer prices on a Web site that consumers could access. In addition, the rule would limit the federal share of the cost of prescription drugs when at least three generic alternatives are available. States would retain their current authority to determine Medicaid reimbursement rates to pharmacies.
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