Association Highlights Improper Maximum Fair Price Denials

In a March 5 letter to the Centers for Medicare & Medicaid Services (CMS), America's Essential Hospitals highlighted member concerns about interactions between the Medicare Drug Price Negotiation Program (MDPNP) and the 340B Drug Pricing Program.

Under the MDPNP, manufacturers must provide access to the lower of the 340B ceiling price or the negotiated maximum fair price (MFP) when both discounts are available to a hospital. However, several essential hospitals have reported instances in which only the MFP should apply, but manufacturers have denied access to that price based on incorrect assumptions about a claim's 340B eligibility.

The letter outlines several examples of improper MFP denials and recommends ways CMS can ensure essential hospitals receive the proper discounts for covered drugs.

Contact Director of Policy Rob Nelb, MPH, at [email protected] or 202.585.0127 with questions.