Federal Upper Limit of Drug Pricing Manufacturer Cost

$79 / 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 data set 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, we 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.
To implement this revision when we calculate the FULs each month, we intend to use the most current monthly National Average Drug Acquisition Cost pricing files. See the Methodology and Data Elements Guide below for further information on the calculation of the Affordable Care Act FUL.
We published the draft Affordable Care Act FULs calculated in accordance with CMS-2345-FC for two months before finalizing the FULs. The final Affordable Care Act FULs are linked below, and 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. Below is the link to the draft January 2016 and February 2016 Affordable Care Act FULs and the Methodology and Data Elements Guide used to calculate the Affordable Care Act FULs.

Date Created

N/A

Last Modified

2018-07-31

Version

2018-07-31

Update Frequency

Monthly

Temporal Coverage

2016-03 to 2018-05-29

Spatial Coverage

USA

Source

John Snow Labs => Centers of Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

None

Source Citation

Federal Upper Limits

Keywords

Federal Upper Limit, Drug pricing, Drug price amount, Medicaid Fee, Medicaid Drug, Manufacturer

Other Titles

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

Name Description Type Constraints
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_TypeAHF, CAP, EA, GM, ML, SUP, TAB, TDPstringrequired : 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_Ratedtrue or falsebooleanrequired : 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
624ESTRADIOL2MGTABLETORALTAB0.074670.13702150268-0292-11trueACA FUL Increased to Equal NADAC
148BACLOFEN10MGTABLETORALTAB0.0517670.09581168084-0855-11trueACA FUL Increased to Equal NADAC
623ESTRADIOL1MGTABLETORALTAB0.0649810.11744150268-0291-11trueACA FUL Increased to Equal NADAC
624ESTRADIOL2MGTABLETORALTAB0.074670.137029000378-1458-77trueACA FUL Increased to Equal NADAC
624ESTRADIOL2MGTABLETORALTAB0.074670.137025050268-0292-15trueACA FUL Increased to Equal NADAC
658ETODOLAC400MGTABLETORALTAB0.255620.48123069036-0503-30trueACA FUL Increased to Equal NADAC
849IBUPROFEN400MGTABLETORALTAB0.007760.0374168084-0658-11trueACA FUL Increased to Equal NADAC
3023ANASTROZOLE1MGTABLETORALTAB0.06250.1306160687-0112-11trueACA FUL Increased to Equal NADAC
6758DAPSONE25MGTABLETORALTAB0.632841.303053013925-0504-30trueACA FUL Increased to Equal NADAC
6758DAPSONE25MGTABLETORALTAB0.632841.303053029033-0036-30trueACA FUL Increased to Equal NADAC