The Minnesota Senate Health and Human Services Committee held a hearing on Nov. 14 on the CMS-Covered Outpatient Drug Rule (COPDR, published in 2016). The Minnesota Department of Human Services (DHS) made a presentation and took testimony on the rule. MPhA member Tim Gallagher of Sterling Pharmacy provided supporting testimony on the DHS proposal, and also gave specific testimony on behalf of MPhA related to the COPDR and another related issue, the impact the wholesale/provider tax has on Minnesota fee-for-service Medical Assistance (MA) reimbursement.
MPhA student pharmacists and others met with key senators on Nov. 14. L-R: Student pharmacists Lindsey Parks, Jacob Shimpa and Kyle Anstett; Senator Jim Abeler, Senator Matt Klein, Senator Chris Eaton, MPhA Past President Tim Gallagher and student pharmacist Gabe Johnson.
The Rule was published to address the rise in prescription drug costs by ensuring that Medicaid programs reform payment methodologies for prescription drugs and to ensure drug rebates accurately reflect market prices. Of consequence to pharmacists across the country and certainly here in Minnesota, the new rule calls for a more transparent/true acquisition cost of drug ingredients to be coupled with a more accurate/true reimbursement rate for dispensing cost.
CMS encouraged States to adopt the National Average Drug Acquisition Cost (NADAC) to calculate the cost of drug ingredients. Minnesota, one of four states still out of compliance with the '16 COPDR, is proposing to change the Minnesota reimbursement equation to the NADAC for ingredient cost and a base reimbursement rate for dispensing cost. The DHS draft proposal proposes a $10.48 reimbursement rate for dispensing cost. The proposal also calls for a periodic survey to determine the reimbursement rate for dispensing cost moving forward (2 or 3 years depending on what's adopted) following an initial survey and implementation.