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Survey of Retail Prices

Survey of Retail Prices: Payment and Utilization Rates and Performance Rankings

CMS entered into a contract with Myers & Stauffer, LC, to perform a survey entitled “Survey of Retail Prices: Payment and Utilization Rates and Performance Rankings”. 

The purpose of this initiative is to perform a monthly nationwide survey of retail community pharmacy prescription drug prices and to provide states with on-going pricing files.  We expect that these pricing files will provide state Medicaid agencies with an array of covered outpatient drug prices concerning acquisition costs and consumer purchase prices.  The state agencies can use this information to compare their own pricing methodologies and payments to those derived from these surveys.

Please note that we are not including specialty pharmacies in the survey at this time.  We will continue to evaluate the inclusion of specialty pharmacies and make a subsequent determination whether specialty pharmacies will be included in the survey.

The Survey of Retail Prices is divided into two parts.

Part I - Retail Community Pharmacy Consumer Prices

Effective July 1, 2013, CMS has suspended Part I of the nationwide retail survey for collecting information about consumer purchase prices, pending funding decisions.  Therefore, the resulting draft NARP file will not be published on Medicaid.gov at this time; however, archive files will remain on the website.  

In addition, the monthly draft New Drug Report file that listed newly marketed single-source drugs has also been suspended.

Part I concerns a nationwide retail survey for collecting information about consumer prices.  A draft methodology document titled Part I: Draft Methodology for Estimating National Average Retail Prices (NARP) for Medicaid Covered Outpatient Drugs [PDF] has been developed to outline the processes to determine statistically valid consumer purchase prices for selected covered outpatient drugs that is based on actual, monthly market transactions, and will be posted on Medicaid.gov. 

This survey incorporates the collection of drug prices from retail community pharmacies and the calculation of consumer prices which will be maintained in a file of consumer unit drug prices.  These unit prices will be averaged to arrive at a NARP, which will be comprised of a statistically weighted average of three payment sources:  cash paying consumers, customers with commercial third party insurance, and Medicaid customers.  Each payment source has unit prices identified by their 11-digit National Drug Code (NDC).

Part I will also include a draft Monthly New Drug Report file that shows newly marketed single-source drugs that are currently generally available.  This will provide states the opportunity to identify newly available covered outpatient drug products to update their coverage policy.

Collection of State Data

Under Part I, we will request state Medicaid agencies to annually provide CMS with information on their prescription drug payment and utilization rates.  We expect to post a comparative ranking to the NARP collected in these surveys.

As a result of the NARP, an annual comparison will also be performed against the top 50 most widely prescribed Medicaid drugs.  These drugs will be determined for the previous Federal fiscal year (FFY), factoring in both utilization and cost.  All states, including the District of Columbia, will be ranked comparing their payment rates against the NARP, in a cost effective payment rate order.  Once the survey results have been finalized under Part II - NADAC, we expect that all state, payment rates and the NARP will be ranked against the NADAC.

In addition to the single-source drug comparisons (comparing the top 50 single source drugs to the NARP), each state will provide claim payment information to determine their generic drug utilization rates.  The ranking of the states’ generic utilization rates will be divided into two categories, generic claim utilization and generic total reimbursement.

Please see below for draft data related to Part I. 

 

PART II - Survey of Drug Acquisition Costs Paid By Retail Community Pharmacies

Part II focuses on the retail community pharmacy acquisition costs. This segment provides for a survey of the purchase prices of all covered outpatient drugs by retail community pharmacies. These pharmacies include independent community pharmacies and chain pharmacies consistent with section 1927(k)(10).  The prices will be updated on a weekly and monthly basis.  A methodology document titled Part II: Methodology for Calculating the National Average Drug Acquisition Cost (NADAC) [PDF] has been developed to outline the processes used to derive the NADAC.  NADAC Questions and Responses [PDF] includes questions and comments received to date regarding the NADAC, along with our responses.  To the extent that states consider the NADAC as a reference price when setting their reimbursement methodology, they must submit a State Plan Amendment (SPA) to CMS in accordance with state plan requirements if they decide to use NADAC as a basis for payment.

Effective November 27, 2013, CMS began posting final NADAC files.  To view the NADAC weekly files and the NADAC Week to Week File Comparison, please visit the Pharmacy Drug Pricing Page.  

Please note that the NADAC file is updated on a weekly basis.  Each month, a new file is posted to reflect findings from the previous month’s survey results incorporating the weekly price changes that have occurred in the interim weeks before the next monthly NADAC file.  For more information on the fields in the NADAC weekly file, please see the NADAC Data Field Definitions [PDF].  In addition, to easily identify and understand the pricing changes that occur each week, we are posting a NADAC Week to Week File Comparison which will accompany the weekly NADAC file.  This comparison file identifies the drug products with current NADAC rates that are replaced with new NADAC rates. Other changes (e.g. NDC additions and terminations) to the NADAC file are not reflected in this comparison. The explanation of the data fields used in the comparison file are further defined in the NADAC Week to Week Comparison Data Field Definitions [PDF].

NADAC Help Desk

Please contact the NADAC Help Desk for support of the NADAC survey, or to provide notification of recent drug price changes that are not reflected in posted NADAC files.
The NADAC Help Desk can be contacted through the following means.

Toll-free phone: (855) 457-5264
Electronic mail: info@mslcrps.com
Facsimile: (317) 815-5478

Please note that the Help Desk will not address pharmacy inquiries into specific State claim reimbursement related questions or concerns.

 

Archived NADAC Files:

Archived NADAC Materials:

Questions about the retail price survey?  Email RPS@cms.hhs.gov.

Page last updated on November 20, 2014