Or. Admin. R. 410-121-0300 – CMS Federal Upper Limits for Drug Payments

(1) The Centers for Medicare and Medicaid Services (CMS) Federal Upper Limits for Drug Payments listing of multiple source drugs meets the criteria set forth in 42 CFR 447.332 and 1927(e) of the Act as amended by OBRA 1993 and the DRA 2005.
(2) Payments for multiple source drugs must not exceed, in the aggregate, payment levels determined by applying to each drug entity a reasonable dispensing fee (established by the State and specified in the State Plan), plus an amount based on the limit per unit. CMS has determined the amount based on the limit per unit to be equal to 250 percent of the Average Manufacturer’s Price (AMP). CMS will post the AMP to a Website available to the public on a quarterly basis.
(3) The FUL drug listing is published in the State Medicaid Manual, Part 6, Payment for Services, Addendum A. The most current Transmittals and subsequent changes are posted to the CMS website https://www.medicaid.gov/medicaid/prescription-drugs/pharmacy-pricing/index.html.

Statutory/Other Authority

ORS 413.042 & 414.065

Statutes/Other Implemented

ORS 414.065

History

DMAP 37-2018, minor correction filed 05/25/2018, effective 05/25/2018
DMAP 36-2008, f. 12-11-08, cert. ef. 1-1-09
DMAP 26-2007, f. 12-11-07, cert. ef. 1-1-08
OMAP 50-2006, f. 12-28-06, cert. ef. 1-1-07
OMAP 13-2006, f. 5-26-06, cert. ef. 6-1-06
OMAP 8-2006(Temp), f. 3-29-06, cert. ef. 4-1-06 thru 9-15-06
OMAP 68-2005, f. 12-21-05, cert. ef. 1-1-06
OMAP 59-2005(Temp), f. 11-8-05, cert. ef. 11-12-05 thru 5-1-06
OMAP 56-2005, f. 10-25-05, cert. ef. 11-1-05
OMAP 29-2005, f. & cert. ef. 6-6-05
OMAP 23-2005(Temp), f. & cert. ef. 4-1-05 thru 9-1-05
OMAP 2-2005, f. 1-31-05, cert. ef. 2-1-05
OMAP 93-2004(Temp), f. & cert. ef. 12-10-04 thru 5-15-05
OMAP 43-2004, f. 6-24-04 cert. ef. 7-1-04
OMAP 32-2004(Temp), f. & cert. ef. 5-14-04 thru 10-15-04
OMAP 2-2004, f. 1-23-04, cert. ef. 2-1-04
OMAP 83-2003(Temp), f. 11-25-03, cert. ef. 12-1-03 thru 4-15-04
OMAP 75-2003, f. & cert. ef. 10-1-03
OMAP 54-2003(Temp), f. & cert. ef. 8-15-03 thru 1-15-03
OMAP 51-2003, f. & cert. ef. 8-5-03
OMAP 41-2003, f. & cert. ef. 5-29-03
OMAP 11-2003(Temp), f. 2-28-03, cert. ef. 3-1-03 thru 8-15-03
OMAP 10-2003, f. 2-28-03, cert. ef. 3-1-03
OMAP 71-2002(Temp), f. & cert. ef. 12-1-02 thru 5-15-03
OMAP 29-2002(Temp), f. 7-15-02, cert. ef. 8-1-02 thru 1-1-03
OMAP 19-2002(Temp), f. & cert. ef. 4-22-02 thru 9-15-02
OMAP 5-2002(Temp), f. & cert. ef. 3-5-02 thru 6-15-02
OMAP 3-2002(Temp), f. & cert. ef. 2-15-02 thru 6-15-02
OMAP 67-2001(Temp), f. 12-28-01, cert. ef. 1-1-02 thru 5-15-02
OMAP 58-2001, f. 11-30-01, cert. ef. 12-1-01
OMAP 51-2001(Temp) f. 9-28-01, cert. ef. 10-1-01 thru 3-15-01
OMAP 26-2001(Temp), f. & cert. ef. 6-6-01 thru 1-2-02
OMAP 23-2001(Temp), f. & cert. ef. 4-16-01 thru 8-1-01
OMAP 18-2001, f. 3-30-01, cert. ef. 4-1-01
OMAP 2-2001(Temp), f. 2-14-01, cert. ef. 2-15-01 thru 7-1-01
OMAP 1-2001(Temp), f. & cert. ef. 2-1-01 thru 6-1-01
OMAP 42-2000(Temp), f. & cert. ef. 12-15-00 thru 5-1-01
OMAP 5-1999, f. & cert. ef. 2-26-99
OMAP 43-1998(Temp), f. & cert. ef. 11-20-98 thru 5-1-99
OMAP 2-1998, f. 1-30-98, cert. ef. 2-1-98
HR 27-1997, f. & cert. ef. 12-1-97
HR 22-1997, f. & cert. ef. 10-1-97
HR 23-1995, f. 12-29-95, cert. ef. 1-1-96
HR 14-1995, f. 6-29-95, cert. ef. 7-1-95
HR 6-1995, f. 3-31-95, cert. ef. 4-1-95
HR 2-1995, f. & cert. ef. 2-1-95
HR 25-1994, f. & cert. ef. 7-1-94
HR 14-1994, f. & cert. ef. 3-1-94
HR 25-1993(Temp), f. & cert. ef. 10-1-93
HR 20-1993, f. & cert. ef. 9-1-93
HR 15-1993(Temp), f. & cert. ef. 7-2-93
HR 11-1993, f. 4-22-93, cert. ef. 4-26-93
HR 8-1993(Temp), f. & cert. ef. 4-1-93
HR 5-1993(Temp), f. 3-10-93, cert. ef. 3-22-93
HR 3-1993, f. & cert. ef. 2-22-93
HR 1-1993(Temp), f. & cert. ef. 1-25-93
HR 35-1992(Temp), f. & cert. ef. 12-1-92
HR 28-1992, f. & cert. ef. 9-1-92
HR 13-1992, f. & cert. ef. 6-1-92
HR 37-1991, f. & cert. ef. 9-16-91
HR 10-1991, f. & cert. ef. 2-19-91
HR 45-1990, f. & cert. ef. 12-28-90
HR 29-1990, f. 8-31-90, cert. ef. 9-1-90
HR 20-1990, f. & cert. ef. 7-9-90
HR 13-1990, f. & cert. ef. 4-20-90, Renumbered from 461-016-0330
HR 3-1990(Temp), f. & cert. ef. 2-23-90
AFS 79-1989, f. & cert. ef. 12-21-89
AFS 63-1989(Temp), f. & cert. ef. 10-17-89
AFS 56-1989, f. 9-28-89, cert. ef. 10-1-89