Thursday, December 31, 2009

HR 3590 and the AMP fix (even more exciting subject matter)

Just a quick note on the supposed "fix" to the Average Manufacturer Price calculations and its impact on the economics of pharmacy.

HR 3590 establishes that the Federal Upper Limit (FUL) shall be no less than 175 percent of the weighted AMP for purposes of medication reimbursement calculations. I've already commented on the problems with the weighted AMP in a previous post.

Does defining the FUL really do anything for pharmacy?

I've looked at the contracts before. I've never seen FUL mentioned in the calculations for reimbursement. All I've ever seen are:
  • Federal MAC
  • WAC
  • AWP minus
  • GEAP
  • Insurer's MAC

All of these *plus* a dispensing fee of $1.75-3.75.

As I see it, this fix does nothing. The insurers are going to continue to reimburse us with the existing formulas and we are going to continue to bleed each and every time we dispense a prescription. With more people supposedly getting coverage through government funded plans, we will see an increased number of opportunities to bleed.

If HR 3590 really wanted to address pricing issues, it would specify which reimbursement formulas that the insurers must use for government funded health plans. Tack on a realistic dispensing fee and maybe we have something.

This concludes today's post.

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