|
Year-end
figures are just being finalized, but we can report that our
year-end disbursement in January 2005 will be increased to our
Active Participating Members again this year by 5-10%. Participation
in our programs is increasing daily and WE thank you for your
SUPPORT.
From AmerisourceBergen
Weekly Legislative Update
Toyota To Build Drugstores for Employees, The Cincinnati Enquirer December
10th, 2004.
Toyota Motor Manufacturing has decided to take a different approach
to lowering health care costs by building their own employee
drugstores. "This is the biggest benefits change we've made
since we started making cars in the United States," a Toyota
spokesman said.
EDITORIAL - Let Toyota know that you will not be using a Toyota
for deliveries or a LEXUS for your family.
Internet Pharmacies face Potential Crackdown in Canada,
The Globe and Mail (Toronto) December 6, 2004
Internet pharmacies based in Manitoba are trying to avoid a government
crackdown that could force them to leave the province. Among
the issues to be discussed at a meeting next week is the practice
of Canadian doctors co-signing prescriptions for patients they
have not seen. The Federal health minister has urged the provinces
to enforce regulations against such practices.
From NCPA
ENEWS, December 15, 2004
It's
Back- Another HIPAA Rule Deadline Approaching
A new HIPAA rule that takes effect April 20, 2005 could cause
more headaches for pharmacies than 2003's privacy rule. The primary
focus of this year's security rule for "pharmacy operations"
is accounting for and the security of electronic transmissions.
The security rule specifically mandates that the pharmacy must
control the "availability, confidentiality, and integrity
of protected health information." Pharmacies must first
understand how their computer systems work, where electronic
files are stored, and what information is being sent off the
pharmacy's premises and to whom. This rule is potentially more
complex and time consuming than the privacy rule, depending on
how a pharmacy's information technology (IT) structure is set
up.
EDITORIAL: - Our endorsed HIPAA Compliance Vendor, PRS Consultants,
has the methodology to keep your store compliant in an easy &
precise method. Call us for details. It is also endorsed
by NCPA, PPA and many other organizations throughout the country.
AUDIT
Information, From June Issue of America's Pharmacist, page 6
Q:
Can Insulin present audit issues?
A: Patients receiving more than 2 vials of insulin per month
may create an audit flag that will result in an onsite audit
of your pharmacy. While it is possible for a patient to use large
amounts of insulin, third parties view two or more vials as unusual.
They believe pharmacies allow patients to stockpile insulin.
Take extra care whenever a patient is using three or more vials
of insulin per month. If the insulin amounts being dispensed
by your pharmacy are justified by the documentation on the hard
copy prescription, you should not have a problem. If all of your
insulin prescriptions state "As directed," expect aggressive
challenges from the third party.
NCPA MEMBERSHIP
DISCOUNT REMINDER
Keystone
has signed up with NCPA as an IPO Corporate Member. One of the
major benefits of this class of membership is that ALL our members
are eligible for a $50.00 discount on their membership in NCPA.
In order to take advantage of this discount you must use a Keystone
form to join or renew. Call our office for the proper
form. Renewals are eligible for this discount also.
Keystone recommends membership in County, State & National
Organizations. NUMBERS MAKE A DIFFERENCE.
New Regulations
in Pennsylvania Medicaid Access Program in February.
Proton Pump Inhibitors (PPI) effective Feb 1st,
OTC Prilosec will be the preferred drug in this therapeutic classification.
All other drugs in this class will require the physician to obtain
Prior Authorization (P.A.). The upper quantity limit of 84 tablets
per month, the dosage limit of 40mg per day, and the length of
the prescription is not to exceed four months for Prilosec OTC.
This regulation will be grandfathered for 4 months for patients
already on another PPI. If availability of OTC Prilosec is not
improved by February 1, 2005, this regulation will be held off
till availability improves. EXCEPTION- Oral liquid or IV forms
of PPIs for recipients age 14 and under and age 65 and older
are exempt from P.A.
Prior Authorization of COX 2 drugs effective February
1, 2005.
The age threshold for P.A. of COX 2 is changed from "under
70 years of age" and not taking an anticoagulant to "under
65 years of age" and not taking an anticoagulant. The clinical
review for P.A. indicating that the recipient has a history of
intolerance or therapeutic failure of at least two (2) non-selective
NSAID's is changed to at least three (3) non-selective NSAID's.
The Pharmacy point of sale on-line claims adjudification system
will audit recipients paid claims history and verify records
of criteria documentation medical necessity and automate P.A.
approvals for COX 2 selective NSAID's. (Editorial no way
they will get this right) Pharmacists are permitted to override
COX 2 selective NSAID NCPDP Reject Code 79-Refill too Soon when
early refill is due to a change in therapy and the change in
therapy is verified by the prescriber (Editorial Document,
Document, Document)
Prior Authorization of Drugs for Erectile Dysfunction
effective February 1, 2005
Approval for requests for P.A. of drugs for ED will be valid
for 24 months. Also clarifies that the current criteria of a
stated diagnosis of ED and a medical evaluation within one year
of the request should include diagnostic testing and a medical
evaluation documenting the stated diagnosis of ED prior to the
request for P.A. Will issue handbook pages that contain updated
requirements and clinical review criteria for P.A. and instructions
to dispense and submit claims for drugs for the treatment of
ED.
Also: a Prescription for an ED cannot authorize any refills.
Quantity limited to four (4) total tablets per month (30 days).
No Emergency supplies can be authorized
COMPLETE DOCUMENTATION ON THE ABOVE CHANGES WILL BE SENT AS A
MEDICAL ASSISTANCE BULLETIN.
New Regulations
in Pennsylvania Medicaid Access Program that we are fighting:
1.
The Department is trying to allow "their pricing service"
(EDS) to choose the lowest of Red Book, Blue Book, or First Data
AWP's. They are trying to do this without going through the "normal
channels" claiming they are not changing any regulation.
We feel this is against present regulations and the PARD is going
through the legislative process to stop this. This 'small"
change would decrease reimbursement by an average of 4.15%.
2. The Department is trying to change reimbursement for
generic drugs by initiating a State Mac list for all generics
that are presently not covered by the Federal Upper Limits (FUL)
list. They would then use the lesser of WAC + 66% +$4.00, or
FUL +$4.00 or State Mac List +$4.00. This would result in a MAJOR
decrease in reimbursement (about 50%) for generic drugs. Most
Pharmacy organizations in the State are preparing responses to
this change in regulation.
3. The PARD has already sent in their response to the
Department, as well as sending a letter to the Governor requesting
that Pharmacy be "Carved-Out" of Managed Care and back
into Fee-For-Service where the State would be eligible to receive
over $200 Million dollars in rebates now going to the Medicaid
HMO's. There has been some favorable response to this request
outside the Department of Welfare.
|