PCAN asks CMS to delay Average Manufacturer Price rule implementation

Here is a link to the submission

Dear Mr. Slavitt and Secretary Burwell,

As the national board chairman of the Pharmacy Choice & Access Now (PCAN) coalition, I am writing to you to urge CMS to delay the effective date of CMS-2345-FC, the Medicaid Final Rule on Covered Outpatient Drugs.

PCAN is a coalition comprised of consumers, local businesses, and pharmacists across the nation committed to preserving quality and affordable health care, and pharmacy services for patients.

On April 1, the rule becomes final and states will have 30 days to implement AMP-based FULs without any requirements to adjust professional dispensing fees.  Once this rule becomes final, local pharmacies will experience reimbursement cuts that will lead to reduced access to prescription drugs and other pharmacy services for Medicaid patients. This quick implementation timeframe leaves local community-based pharmacies at risk.

We certainly appreciate CMS’s commitment and work towards clarifying Medicaid AMP calculations, and finalizing this much-anticipated rule marks a shift towards pharmacy reimbursement on a cost-based methodology. However, given the complexity and vastness of the final rule, PCAN has serious concerns about the ability of local community-based pharmacies and others in the healthcare supply chain to meet this narrow deadline for implementation.

Therefore, we are specifically requesting an extension of the final rule to October 1, 2016. Unlike many – if not most – rules from Federal departments and agencies, CMS-2345-FC carries with it the implicit requirement that states decide how, or if, to hold harmless, pharmacies who may suffer significant financial hardship by reductions in their acquisition costs with no counter-balancing of increases in their dispensing costs.  These increases need approval at the state level to hold pharmacies harmless under this rule.

We request that CMS take “judicial notice” of this state-by-state activity and give local pharmacies and other healthcare stakeholders the opportunity to reach out to their state legislators and help them fully understand the scope of this rule.

We understand the effective date is driven by the start of Fiscal Year 2017, but we ask that we not be held hostage to the calendar and that we be given sufficient time to make certain our members and their customers are in a position to cope with this new rule.


Bill Mincy
National Board Chairman
Pharmacy Choice & Access Now (PCAN)