December 4, 2009
Dear Colleague,
This morning I had separate face-to-face meetings with two of the most influential legislators in Congress: Reps. Steny Hoyer (D-Md.), the House majority leader, and Henry Waxman (D-Calif.), chairman of the House Energy & Commerce Committee. Hoyer is the second-ranking Democrat in the House after Speaker Pelosi. Waxman leads one of the three House committees that crafted the health care reform bill (H.R. 3962, the Affordable Health Care for America Act) that passed the House last month. Accompanying me in the meeting with Hoyer was Howard Schiff, executive director of the Maryland Pharmacists Association, and John Coster, NCPA sr. v.p. for government affairs.
First off in both meetings, we thanked them for their current and past support of independent community pharmacy. Then we asked for some more.
On accreditation, we were encouraged that they both had backed efforts earlier this fall by Rep. Zach Space (D-Ohio) to secure an extension of the deadline by which pharmacy suppliers of Medicare Part B DMEPOS had to obtain accreditation. Space's bill, which became P.L. 111-72, pushed the deadline from Oct. 1, 2009 to Jan. 1, 2010. (Sens. Tester and Grassley helped get it through the Senate.)
Both the House health care reform bill and the Senate's (H.R. 3590, the Patient Protection and Affordable Care Act) include an accreditation exemption for pharmacies under some circumstances. However, enactment of any health care reform measure by Jan. 1 is unlikely.
This morning, we told Hoyer and Waxman of our concern that CMS will start revoking pharmacy billing numbers if they have not been accredited by Jan. 1. We suggested to the lawmakers that they consider an extension to April 1, 2010 to avoid having any pharmacies lose their Medicare billing privileges before, we hope, Congress changes the accreditation requirements in the final health care reform legislation. They indicated that our issue would be included in "extender bills" needed in several areas before health care reform is enacted.
We also expressed a preference for the approach taken in the Senate bill: an exemption from accreditation for any pharmacy with Medicare DME sales 5% or less of their total Medicare sales. I think that is cleaner than the path that passed the House—waiving the accreditation requirements for the sale of diabetes testing supplies, canes, and crutches.
A tougher task concerns AMP. Both the House and Senate reform bills attempt to fix the unfair and potentially devastating Medicaid reimbursement scheme wrought by the Deficit Reduction Act of 2005 and a CMS regulation attempting to implement it. Our lawsuit with NACDS has successfully blocked implementation for the last two years.
The House bill calls for FULs for generic drugs to be calculated at 130% of a weighted average AMP. The Senate approach uses a multiplier of 175%.
Both are an improvement. Neither is sufficient, however, in our judgment. We noted that in the last Congress we supported H.R. 3700, sponsored by Rep. Frank Pallone (D-N.J.), chairman of Waxman's health subcommittee. That bill would have set the reimbursement rate for generics at 300% of a multiple source product's weighted average AMP.
We told the lawmakers (and Speaker Pelosi, too, in an earlier letter) that the 300% figure is necessary because in most states the Medicaid dispensing fees are well below our costs of dispensing.
We know that this percentage may be unrealistic in today's economic environment, but that we remain concerned that reimbursement for generics at no more than 130% of the weighted average AMP, combined with the low dispensing fees paid by states, could have us dispensing drugs at a loss, and so could 175%.
I think we made a compelling case. They seemed to agree, and Waxman said he would take a close look at AMP when he'll be a lead figure in reconciling the House version with whatever passes the Senate.
Overall I'm encouraged, but with the Senate debate expected to last at least until Christmas, we have a long way to go.
Regards,
Bruce Roberts
NCPA
Please take the time talk to your representatives and senators - the future of your profession needs these problems to be adjusted RIGHT NOW.
A Simple reminder --- Membership in NCPA should be mandatory for every practicing pharmacist, but it is not.
Please consider allowing Keystone to subtract your NCPA dues from your Keystone rebates yearly. Just call our office & we will send you a form to sign to allow us to do this on your behalf.
Thanks
Mel