Impact to MaineCare of Average Manufacturer Price (AMP) Cap Removal

Jan 02, 2024

As the result of a provision in the American Rescue Plan (ARP) Act of 2021, beginning January 1, 2024, Medicaid rebates from drug manufacturers will no longer be capped at 100 percent of the quarterly AMP. 

By increasing the number of rebates that manufacturers pay to the government for drugs that are covered by Medicaid, it is estimated that this policy will save the government $15 - 20 billion1 in Medicaid spending between 2019 and 2029.  

With approximately 15 – 20% of brand drugs currently capped at AMP2, the removal of the AMP cap will increase the total rebate for those drugs to more than 100% of AMP.  

How does this impact MaineCare and MaineCare members?  

Manufacturers will evaluate drugs with high list prices or high rebates for potential impact. They may make changes to their drug portfolio to prevent revenue losses. As part of this evaluation process to date, these products are being discontinued: Flovent Diskus, Flovent HFA, Imitrex Nasal Spray, Ciprodex and Tobradex.  

MaineCare continues to monitor changes as they become available and will update the PDL to offer alternatives to supplement these product discontinuations. 

For questions, please contact the Change Healthcare Pharmacy Help Desk at 1-888-420-9711. Maine providers can also send inquiries via email to PBA_helpdesk@changehealthcare.com.   

 

1 Medicaid and CHIP Payment and Access Commission, MACPAC.(2019). Next Steps in Improving Medicaid Prescription Drug Policy. Next-Steps-in-Improving-Medicaid-Prescription-Drug-Policy.pdf (SECURED) (macpac.gov) 

2 IQVIA (April 24, 2023). The Impact of AMP Cap Removal on Medicaid Drug Prices. Retrieved December 22, 2023, from https://www.iqvia.com/locations/united-states/blogs/2023/04/the-impact-of-amp-cap-removal-on-medicaid-drug-prices.