Maryland Drug Fee Schedule, Take 2

Medicare Set-Aside Blog on November 8, 2011
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Maryland is taking a second attempt at implementing a state pharmaceutical fee schedule. A previous attempt last January was based upon generic equivalent average price (GEAP) and was strongly opposed as it is not a readily accessible standard. The newest version of the regs adopt an AWP standard, as is common in many other jurisdictions. The regs set the price for brand names at AWP minus 10% plus a $3 dispensing fee and generics are capped at AWP minus 10% plus a $5 dispensing fee. While there is still strong opposition by physician groups that continue to feel in-office dispensing is important to patient care and that need the markup to compensate them for the inconvenience, the proposal appears reasonable enough and will help significantly curb some of the outrageous drug spends we see here in Maryland. Now the real question is if adopted officially into law, will CMS continue to force Maryland payers to allocate AWP in WCMSAs without any discounts???

[Don’t waste your time hoping – I think you know the answer]

View the proposed legislation here