WASHINGTON – A rare admission by the federal government that there are legitimate concerns surrounding a prescription pricing approach is a first step to resolving a lawsuit by groups representing community pharmacies.
However, those groups say the concessions by the Centers for Medicare & Medicaid Services won’t end the debate over the prescription price formula that CMS is trying to implement for pharmacies serving Medicaid recipients.
The National Community Pharmacists Association and the National Association of Chain Drug Stores say they will leave their legal options open while pursuing a legislative review of the pricing approach.
In December, a court ruled in favor of the associations’ suit, saying the pricing approach based on the average manufacturers price is flawed and could cause irreparable harm to thousands of pharmacies.
Last month, CMS acknowledged serious legal concerns about its definition of a multiple source drug, and it revised the definition contained in the original rule, issued last July.
The revision came in response to the lawsuit. While it was a positive first step, it doesn’t address the issues that prompted legal action by the groups, said Charlie Sewell, senior vice president of government affairs for the NCPA.
“We’re glad they listened to the judge and made the modification, but a lot more needs to be done,” Sewell said. It’s uncertain if CMS will revamp other aspects of the prescription pricing methodology.
The trade groups point to reports by the Government Accountability Office and the Office of the Inspector General for the agency, which found that pharmacies paid under the rule would get less for prescription reimbursements than they would pay for the drugs.
“In (CMS’) zeal to cut costs, I don’t think they paid much attention to the potential impact of the formula,” Sewell said.