[ROWS] 1945283
[PAGES] 244
[FIELDS] 14
[MODIFIED] 2025-04-28
[DOWNLOAD] https://download.medicaid.gov/data/aca-federal-upper-limits-04282025.csv
[DICTIONARY] https://data.medicaid.gov/api/1/metastore/schemas/data-dictionary/items/407b1e31-27a5-42c5-947a-374aa67dbf02
31 ACA Federal Upper Limits
Affordable Care Act Federal Upper Limits (FUL) based on the weighted average of the most recently reported monthly average manufacturer price (AMP) for pharmaceutical and therapeutically equivalent multiple source drug products that are available for purchase by retail community pharmacies on a nationwide basis.
Metadata
Dictionary
product_group
The following methodology forms a Product Group:
Include all innovator (I) and non-innovator (N)
pharmaceutically and therapeutically equivalent
(A-rated) multiple source drugs when calculating
the weighted average of monthly AMPs in a FUL
Product Group; Will not include single source
(S) drugs when calculating the weighted average
of monthly AMPs in a FUL Product Group; Will
not include formulations of the drug that are
not rated by the FDA as pharmaceutically and
therapeutically equivalent to the reference listed
drug, (A-rated) in the calculation of the weighted
average of monthly AMPs, or apply the FUL to
those formulations that are not A-rated, e.g.,
B-rated drugs; Will use the monthly AMP and AMP
units reported and certified by manufacturers to
calculate the weighted average of monthly AMPs in
a FUL Product Group; and, Will not include the AMP
of a terminated drug in the weighted average of
monthly AMPs.
ingredient
The order of ingredients presented in the product
labeleling.
strength
The strengths presented in the product labeleling.
dosage
The dosage form of the drug.
route
The route of administration of the drug.
mdr_unit_type
The unit type reported to the CMS Medicaid Drug
Rebate Program.
weighted_average_amps
The calculated weighted average of the monthly
amps for the group.
aca_ful
The calculated Federal Upper Limit (FUL) for the
group.
package_size
Identifies the number of billing units in the
package quantity from which the pharmacist
dispenses.
ndc
The National Drug Code (NDC) is a numerical code
maintained by the FDA that includes the labeler
code, product code, and package code.
arated
Identifies if the drug is an A-rated drug, (Yes or
No).
multiplier_greater_than_175_percent_of_weighted_avg_of_amps
ACA FUL equals the most current average retail
community pharmacies' acquisition cost (NADAC)
= Y ACA FUL equals 175 percent of the weighted
average of the most recently reported monthly
AMPs = N Note: All NDC-11s for a FUL Product Group
are included in this file; however, only the (I)
and (N), A-rated, multiple source drugs are used
to calculate the weighted average of the most
recently reported monthly AMPs in a FUL Product
Group.
year
The year in which the FUL was calculated.
month
The month in which the FUL was calculated.
Data
tibble [8,000 × 14] (S3: tbl_df/tbl/data.frame)
$ product_group : chr [1:8000] "1165" "4486" "2662" "1912" ...
$ ingredient : chr [1:8000] "NYSTATIN" "OLMESARTAN MEDOXOMIL" "RIVASTIGMINE TARTRATE" "QUINAPRIL HYDROCHLORIDE" ...
$ strength : chr [1:8000] "500000U" "20MG" "3MG" "5MG" ...
$ dosage : chr [1:8000] "TABLET" "TABLET" "CAPSULE" "TABLET" ...
$ route : chr [1:8000] "ORAL" "ORAL" "ORAL" "ORAL" ...
$ mdr_unit_type : Factor w/ 6 levels "CAP","GM","ML",..: 5 5 1 5 5 5 1 1 1 5 ...
$ aca_ful : num [1:8000] 0.4416 0.6728 0.3296 0.1307 0.0935 ...
$ package_size : int [1:8000] 100 30 500 90 90 100 90 90 100 100 ...
$ ndc : chr [1:8000] "23155-0051-01" "68462-0437-30" "33342-0090-15" "68180-0556-09" ...
$ arated : chr [1:8000] "Yes" "Yes" "Yes" "Yes" ...
$ year : int [1:8000] 2019 2019 2019 2019 2019 2019 2019 2019 2019 2019 ...
$ month : int [1:8000] 2 2 2 2 2 2 2 2 2 2 ...
$ amp_wt_avg : num [1:8000] 0.159 0.3845 0.0385 0.047 0.0535 ...
$ gt_175pc_amp_wt_avg: int [1:8000] 1 0 1 1 0 0 0 0 1 1 ...
Distribution
Variable | Mean | SD | IQR | Range | Skewness
------------------------------------------------------------------------------
aca_ful | 1.43 | 5.56 | 0.74 | [3.28e-03, 127.26] | 13.10
package_size | 227.45 | 557.17 | 70.00 | [1.00, 28000.00] | 21.21
year | 2019.00 | 0.00 | 0.00 | [2019.00, 2019.00] |
month | 2.00 | 0.17 | 0.00 | [2.00, 11.00] | 51.62
amp_wt_avg | 0.75 | 3.08 | 0.37 | [1.87e-03, 72.72] | 13.91
gt_175pc_amp_wt_avg | 0.38 | 0.48 | 1.00 | [0.00, 1.00] | 0.51
Variable | Kurtosis | n | n_Missing
-------------------------------------------------
aca_ful | 236.32 | 8000 | 0
package_size | 849.35 | 8000 | 0
year | | 8000 | 0
month | 2663.33 | 8000 | 0
amp_wt_avg | 264.56 | 8000 | 0
gt_175pc_amp_wt_avg | -1.74 | 8000 | 0
