Medicaid Outpatient Prescription Drugs: Second Quarter 2008 Federal Upper Limits for Reimbursement Compared with Average Retail Pharmacy Acquisition Costs

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DIANE Publishing, 2010 - 35 pages
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Medicaid spent $15 billion on outpatient prescription drugs (PD) in FY 2007. Instead of directly purchasing PD, state Medicaid programs reimburse pharmacies for dispensing them to Medicaid beneficiaries. For certain PD, state Medicaid programs may only receive fed. matching funds for reimburse. up to a max. amount known as a fed. upper limit (FUL). The Deficit Reduction Act of 2005 changed the methodology for calculating FULs. This report found that if AMP-based FULs had been in place in the 2nd qtr. of 2008, they would have been lower than avg. retail pharmacy costs for most of the drugs in the sample and in the nat. aggregate. However, 64 drugs had at least one therapeutically equivalent version with acquisition costs below the FUL. Illus.

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