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January 2004

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.


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