Survey of Retail Prices
Latest Update
October 5, 2012 - CMS is posting draft National Average Retail Price (NARP) data for stakeholder review and comment. The draft NARP reflects prices paid for drugs to retail community pharmacies for individuals with Medicaid, cash paying customers, and those with certain third party insurance. The file also provides a weighted average of these three prices. There will also be a draft Monthly New Drug Report that shows newly marketed single-source drugs.
The draft NARP drug file information, once finalized, can be useful to the states to measure their reimbursement methodology to pharmacy providers. We expect that this reference pricing will assist states in comparing their current pricing policies to that reflected in the draft NARP.
CMS is also posting draft National Average Drug Acquisition Cost (NADAC) data for stakeholder review and comment. These data are based on a voluntary survey of pharmacy invoices.
We anticipate that states may consider applying the draft NADAC, once finalized, for drugs subject to the Federal Upper Limits (FUL), http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Federal-Upper-Limits-.html as well as using the NADAC, once finalized, for setting their state reimbursement rates for other covered outpatient drugs. Any state that wishes to change its pharmacy reimbursement methodology will need to submit a state plan amendment to CMS for review and approval.
After we consider comments on the draft NARP files, the draft NADAC files and the draft Monthly New Drug Report, we plan to release these data files in final, with updated files posted on at least a monthly basis.
Comments on these pricing data should be submitted to RPS@cms.hhs.gov.
Survey of Retail Prices: Payment and Utilization Rates and Performance Rankings
CMS entered into a contract with Myers & Stauffer, LC, to perform a survey entitled “Survey of Retail Prices: Payment and Utilization Rates and Performance Rankings”.
The purpose of this initiative is to perform a monthly nationwide survey of retail community pharmacy prescription drug prices and to provide states with on-going pricing files. We expect that these pricing files will provide state Medicaid agencies with an array of covered outpatient drug prices concerning acquisition costs and consumer purchase prices. The State agencies can use this information to compare their own pricing methodologies and payments to those derived from these surveys.
Please note that we are not including specialty pharmacies in the survey at this time. We will continue to evaluate the inclusion of specialty pharmacies and make a subsequent determination whether specialty pharmacies will be included in the survey.
The Survey of Retail Prices is divided into two parts.
Part I - Retail Community Pharmacy Consumer Prices
Part I concerns a nationwide retail survey for collecting information about consumer prices. A draft methodology document titled Part I: Draft Methodology for Estimating National Average Retail Prices (NARP) for Medicaid Covered Outpatient Drugs has been developed to outline the processes to determine statistically valid consumer purchase prices for selected covered outpatient drugs that is based on actual, monthly market transactions, and will be posted on Medicaid.gov.
This survey incorporates the collection of drug prices from retail community pharmacies and the calculation of consumer prices which will be maintained in a file of consumer unit drug prices. These unit prices will be averaged to arrive at a NARP, which will be comprised of a statistically weighted average of three payment sources: cash paying consumers, customers with commercial third party insurance, and Medicaid customers. Each payment source has unit prices identified by their 11-digit National Drug Code (NDC).
Part I will also include a draft Monthly New Drug Report file that shows newly marketed single-source drugs that are currently generally available. This will provide states the opportunity to identify newly available covered outpatient drug products to update their coverage policy.
Please see below for draft data related to Part I. We seek review and comments on this data. Please respond to RPS@cms.hhs.gov.
PART II - Survey Of Drug Acquisition Costs Paid By Retail Community Pharmacies
Part II focuses on the retail community pharmacy acquisition costs. This segment provides for a survey of the purchase prices of all covered outpatient drugs by retail community pharmacies. These pharmacies include independent community pharmacies and chain pharmacies consistent with section 1927(k)(10). We expect to update the prices on a weekly and monthly basis. A draft methodology document titled Part II: Draft Methodology for Calculating the National Drug Acquisition Cost (NADAC) has been developed to outline the processes used to derive the NADAC, taking into consideration any regional and pharmacy purchasing differences to obtain an acquisition price for covered outpatient drugs. We expect that states may consider the NADAC as a reference price when setting their reimbursement methodology.
Below are the draft NADAC file and the data field definitions for the file. Please note that the draft NADAC file will be updated on a weekly basis and we will not be maintaining any prior NADAC files on the website
We seek review and comments on this draft data. Please respond to RPS@cms.hhs.gov.
Due to recent technical difficulties with our website, we will retain the NADAC file posted on October 5 for reference in addition to posting the weekly update. Both files will be replaced with the next weekly update.
Collection of State Data
Under Part I, we will request state Medicaid agencies to annually provide CMS with information on their prescription drug payment and utilization rates. We expect to post a comparative ranking to the NARP collected in these surveys.
As a result of the NARP, an annual comparison will also be performed against the top 50 most widely prescribed Medicaid drugs. These drugs will be determined for the previous Federal fiscal year (FFY), factoring in both utilization and cost. All states, including the District of Columbia, will be ranked comparing their payment rates against the NARP, in a cost effective payment rate order. Once the survey results have been finalized under Part II - NADAC, we expect that all state, payment rates and the NARP will be ranked against the NADAC.
In addition to the single-source drug comparisons (comparing the top 50 single source drugs to the NARP), each state will provide claim payment information to determine their generic drug utilization rates. The ranking of the states’ generic utilization rates will be divided into two categories, generic claim utilization and generic total reimbursement.
Archived Presentations:
Questions about the retail price survey? Email RPS@cms.hhs.gov.
Page last updated on October 11, 2012