Others titles

  • Federal Upper Limits of Drug Pricing Medicaid Fee
  • Federal Upper Limits of Medicaid Drug Pricing
  • Federal Upper Limits of Manufacturer Drug Pricing

Keywords

  • Federal Upper Limit
  • Drug Pricing
  • Drug Price Amount
  • Medicaid Fee
  • Medicaid Drug
  • Drug Manufacturer
  • Affordable Care Act
  • Drug Products
  • Drug Information
  • FUL

Federal Upper Limit of Drug Pricing Manufacturer Cost

The Federal Upper Limit (FUL) is 175% or more than the weighted average of the monthly average manufacturer prices (AMP) for purchasable pharmaceutically and therapeutically equivalent multiple source drug products. This dataset includes FUL with Medicaid Drug Rebate information.

Log in to download
Complexity

Get The Data

  • The data in CSV format DOWNLOAD
  • Metadata in Human Readable format (PDF) DOWNLOAD
  • Metadata in Machine Readable format (JSON) DOWNLOAD
Your Data License
  • Research
    Non-Commercial, Share-Alike, Attribution Free Forever
  • Commercial
    Commercial Use, Remix & Adapt, White Label Buy Subscription

Description

The Affordable Care Act revised the Federal Upper Limit (FUL) provisions to require that the Secretary calculate the FULs as no less than 175 percent of the weighted average (determined on the basis of utilization) of the most recently reported monthly average manufacturer prices (AMP) for pharmaceutically and therapeutically equivalent multiple source drug products that are available for purchase by retail community pharmacies on a nationwide basis. In accordance with these provisions, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-2345-P) that FULs would be calculated as 175 percent of the weighted average of AMPs.
In accordance with the final regulation with comment (CMS-2345-FC), we established an exception to the FUL calculation which allows for the use of a higher multiplier to calculate the FULs based on acquisition costs for certain multiple source drugs.
Specifically, they finalized an exception to calculating the FUL at an amount equal to 175 percent of the weighted average of the most recently reported monthly AMPs for pharmaceutically and therapeutically equivalent multiple source drugs in instances where that amount is less than the average retail community pharmacies’ acquisition cost for such drugs as determined by the most current national survey of such costs. In situations where the FUL is less than the average retail community pharmacies’ acquisition cost, we will establish the FUL using a higher multiplier so that the FUL amount would equal the most current average retail community pharmacies acquisition cost as determined by the most current national survey of such costs.
The final Affordable Care Act FULs will be effective on April 1, 2016 to coincide with the effective date of CMS-2345-FC. States will have up to 30 days from the April 1, 2016 effective date to implement the FULs. Thereafter, the FULs will be updated monthly on the Medicaid.gov website, and will be effective on the first date of the month following the publication of the update. States will, likewise, have up to 30 days after the effective date to implement the FULs.

About this Dataset

Data Info

Date Created

2016-04-01

Last Modified

2020-09-30

Version

2020-09

Update Frequency

Monthly

Temporal Coverage

2016-03 to 2018-05-29

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Federal Upper Limit, Drug Pricing, Drug Price Amount, Medicaid Fee, Medicaid Drug, Drug Manufacturer, Affordable Care Act, Drug Products, Drug Information, FUL

Other Titles

Federal Upper Limits of Drug Pricing Medicaid Fee, Federal Upper Limits of Medicaid Drug Pricing, Federal Upper Limits of Manufacturer Drug Pricing

Data Fields

Name Description Type Constraints
Product_GroupProduct group of the drugintegerlevel : Nominal required : 1
IngredientIngredient of the drugstringrequired : 1
StrengthStrength of the drugstringrequired : 1
DosageType of dosagestringrequired : 1
RouteDelivery method for the drugstringrequired : 1
Minimum_Daily_Requirement_Unit_TypeThe Unit type (tablet, suppository...) of the MDR (Minimum Daily Rate)stringrequired : 1
Weighted_Average_Average_Manufacturer_PricesMonthly Weighted Average Manufacturer Pricesnumberlevel : Ratio required : 1
Affordable_Care_Act_Federal_Upper_LimitAffordable Care Act Federal Upper Limitnumberlevel : Ratio required : 1
Package_SizePackage sizenumberlevel : Ratio required : 1
National_Drug_CodeNDC Codestringrequired : 1
Is_A_RatedPrecise if the drug is rated by FDA.booleanrequired : 1
Multiplier_Greater_Than_175_Percent_of_Weighted_Avg_of_AMPs"ACA FUL Increased to Equal NADAC" or "ACA FUL Equals 175 Percent of Weighted Average of AMPs"stringrequired : 1

Data Preview

Product GroupIngredientStrengthDosageRouteMinimum Daily Requirement Unit TypeWeighted Average Average Manufacturer PricesAffordable Care Act Federal Upper LimitPackage SizeNational Drug CodeIs A RatedMultiplier Greater Than 175 Percent of Weighted Avg of AMPs
3009OMEPRAZOLE; SODIUM BICARBONATE40MG;1.1GMCAPSULEORALCAP2.7004734.7258283068682-0104-30TrueACA FUL Equals 175 Percent of Weighted Average of AMPs
3009OMEPRAZOLE; SODIUM BICARBONATE40MG;1.1GMCAPSULEORALCAP2.7004734.7258283069097-0914-02TrueACA FUL Equals 175 Percent of Weighted Average of AMPs
3009OMEPRAZOLE; SODIUM BICARBONATE40MG;1.1GMCAPSULEORALCAP2.7004734.7258283069367-0196-30TrueACA FUL Equals 175 Percent of Weighted Average of AMPs
3019VORICONAZOLE200MGTABLETORALTAB1.282933.66981999999999963000049-3180-30TrueACA FUL Increased to Equal NADAC
3019VORICONAZOLE200MGTABLETORALTAB1.282933.66981999999999963000378-1640-93TrueACA FUL Increased to Equal NADAC
3019VORICONAZOLE200MGTABLETORALTAB1.282933.66981999999999963000781-5668-31TrueACA FUL Increased to Equal NADAC
3019VORICONAZOLE200MGTABLETORALTAB1.282933.66981999999999963000904-6471-04TrueACA FUL Increased to Equal NADAC
3019VORICONAZOLE200MGTABLETORALTAB1.282933.66981999999999963027241-0063-03TrueACA FUL Increased to Equal NADAC
3019VORICONAZOLE200MGTABLETORALTAB1.282933.66981999999999963043386-0089-03TrueACA FUL Increased to Equal NADAC
3019VORICONAZOLE200MGTABLETORALTAB1.282933.66981999999999963043547-0378-03TrueACA FUL Increased to Equal NADAC