Federal Upper Limit of Drug Pricing Manufacturer Cost

$179 / year

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.

Complexity

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.

Date Created

2016-04-01

Last Modified

2019-04-30

Version

2019-04-30

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

NameDescriptionTypeConstraints
Product_GroupProduct group of the drugintegerrequired : 1 level : Nominal
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 Pricesnumberrequired : 1 level : Ratio
Affordable_Care_Act_Federal_Upper_LimitAffordable Care Act Federal Upper Limitnumberrequired : 1 level : Ratio
Package_SizePackage sizenumberrequired : 1 level : Ratio
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
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
726GLIPIZIDE5MGTABLETORALTAB0.01470.03244151079-0810-01trueACA FUL Increased to Equal NADAC
148BACLOFEN10MGTABLETORALTAB0.0460590.0921168084-0855-11trueACA FUL Increased to Equal NADAC
149BACLOFEN20MGTABLETORALTAB0.082280.18922168084-0868-11trueACA FUL Increased to Equal NADAC
491DIAZEPAM2MGTABLETORALTAB0.0090370.02097151079-0284-01trueACA FUL Increased to Equal NADAC
492DIAZEPAM5MGTABLETORALTAB0.0088750.02412151079-0285-01trueACA FUL Increased to Equal NADAC
726GLIPIZIDE5MGTABLETORALTAB0.01470.032443068645-0150-54trueACA FUL Increased to Equal NADAC
726GLIPIZIDE5MGTABLETORALTAB0.01470.032443068645-0574-54trueACA FUL Increased to Equal NADAC
490DIAZEPAM10MGTABLETORALTAB0.0127380.02716151079-0286-01trueACA FUL Increased to Equal NADAC
692FOLIC ACID1MGTABLETORALTAB0.015680.03356151079-0105-01trueACA FUL Increased to Equal NADAC
692FOLIC ACID1MGTABLETORALTAB0.015680.03356162584-0897-11trueACA FUL Increased to Equal NADAC