CMS Expands Meaning Of “Retail Community Pharmacy” In AMP Rule

CMS’ proposed rule on the average manufacturer price for drugs includes specialty and home infusion pharmacies in the law’s definition of “retail community pharmacy” for the purpose of calculating AMP, citing drugs subject to Risk Evaluation and Mitigation Strategies from FDA as the reason.

FDA’s Risk Evaluation and Mitigation Strategy program is having an unexpected influence on how CMS plans to define “retail community pharmacy” for the purpose of calculating average manufacturer prices for drugs. Because some REMS drugs may be limited to distribution through specialty and home infusion pharmacies, CMS is proposing to add them to the list of entities mentioned in the Affordable Care Act as a retail community pharmacy.

In CMS’ proposed rule on covered outpatient drugs in Medicaid issued Jan. 27, the agency implements a number of provisions...

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