Please Contact your Members of Congress to support:
H.R. 1971/S. 1058 (PBM Reform/McMorris Rodgers; Pryor-Moran),
H.R. 1946 (PBM Negotiations/Marino) and
H.R. 1936 (DME/Schock-Welch)
___________________________________________________________________________
NCPA OPPOSES ESI-MEDCO MERGER
CONTACT YOUR MEMBERS OF CONGRESS TODAY!
NCPA has launched a Congressional campaign to convince the Federal Trade Commission (FTC) to NOT approve the merger of ESI and Medco. We ask all NCPA members to contact their House and Senate offices and ask them to contact the FTC, urging that the merger be denied. Approval of the merger means higher drug prices, less competition, more egregious PBM practices, fewer consumer choices, and more mail order! Please go to the NCPA website www.ncpanet.org to contact your Member of Congress today! Time is of the essence! Please act today! Thank you.
· NCPA sent a "call to action" to all community pharmacies regarding the merger between Medco and Express Scripts. Members were asked to contact their Members of Congress, state Attorney General, Insurance Commissioner, state legislators and Governor and request that these officials voice their concern and opposition to the FTC over this merger.
· This week NCPA contacted numerous interest groups who represent different levels and sectors of state government. The goal of this contact is to develop relationships that will assist NCPA’s state advocacy efforts in opposition of the merger between Medco and Express Scripts. Groups contacted included: NGA, DGA, NAAG, NCOIL, RGA, CSG and NCLS.
· NCPA held a conference call with the National Conference of Insurance Legislators (NCOIL) regarding the merger between Medco and Express Scripts. NCPA will follow-up this contact by providing NCOIL with materials on both the Express Scripts and Medco merger and other PBM efforts.
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Debt Limit Bill Becomes Law: The House finally voted on final passage of the debt limit deal. The measure passed by a vote of 269 to 161. 174 Republicans and 95 Democrats supported the package. It then passed the Senate and the bill was signed into law by the President shortly after.
NCPA will now focus its lobbying efforts on the Joint Select Committee on Deficit Reduction, which will be comprised of 12 Members of Congress (appointed no later than 14 days after passage of the bill - Tuesday August 16, 2011). Its charge is to put forth a proposal to cut spending by $1.2 trillion by November 23, 2011, and Congress is required to vote on the recommendations by December 23, 2011. Each Chamber would consider the proposal on an up or down vote without amendments. If the Committee can't agree to recommendations, the President may still request up to $1.2 trillion for a debt limit increase. Such action would activate the "trigger" of $1.2 trillion in across-the-board cuts--half would be Defense cuts and the other half would be non-Defense cuts. Non-defense cuts would exempt Social Security and Medicaid, and only impact providers in Medicare. Medicare cuts could not exceed 2 percent, which is about $11 billion in 2013.
The Members of Congress chosen to sit on the Select Committee will have the daunting task of making spending cut recommendations in a few months time. While Congressional Committees can submit recommendations to the Select Committee no later than October 14th, unquestionably the 12 appointed Members will be crucial in developing the recommended cuts. A number of names are already being floated in both Chambers for the Select Committee. NCPA will follow this process closely and build our lobbying strategy around the structure and timing of the Select Committee.
NCPA is developing an analysis that will document that, combining the cuts to reimbursement in Medicare Part D and Medicaid, community pharmacies have already “given at the office” in terms of cost savings in these Federal programs.
NCPA Survey Shows Negative Impact of PBM Practices on Patient Care, Pharmacies: This week, NCPA released a survey of about 1900 of its members, showing how burdensome and onerous PBM reimbursement and auditing practices are standing in the way of good patient care. The survey focused primarily on the fact that PBM contracts do not disclose even basic information on how MACs are set or changed for generics. It also shows how PBMs use audits to harass pharmacists and recover thousands of dollars in legitimate prescriptions dispensed even for the slightest clerical errors. NCPA will be using these surveys to lobby Members of Congress to support H.R. 1971/S. 1058, the Pharmacy Competition and Consumer Choice Act, as well as H.R. 1946, the Save our Independent Hometown Pharmacies Act. A copy of the national survey is attached, but individual results for most states will be on the NCPA website this week.
PCMA: Drugstores Want a “Free Pass” to Avoid FWA Detection: In response to the NCPA survey showing how PBMs harass pharmacies with egregious audits, PCMA (the Pharmaceutical Care Management Association, representing the PBM lobby) released a statement saying that “the independent drug store lobby” wants to avoid fraud waste and abuse detection. PCMA came out in opposition to H.R. 1971/S. 1058. Not surprising for the PBM industry, the statement is full of inaccuracies of what the bill contains. PBMs are also interested in taking away the hard-fought Medicare Part D prompt pay provisions enacted in 2008 because they miss the millions of dollars in revenue that they earned from the “float” by keeping community pharmacies reimbursements for excessive periods of time. Make no mistake. The PBMs and their allies are using the FWA issue to hide behind their egregious PBM auditing practices – and are laying the ground work for making a run at the Part D prompt pay provisions. A copy of the NCPA response is attached.
NCPA Weighs in on Legislation Expanding 340B program: Reps. McMorris Rodgers (R-WA), Rush (D-IL) and Emerson (R-MO) recently introduced legislation to expand 340B drug coverage to inpatient drugs and to repeal the orphan drug exclusion. While these two provisions do not directly impact NCPA, we remain concerned regarding another provision in the proposed legislation which would, to some extent, expand the outpatient program by allowing children’s and rural hospitals to utilize 340B discounts in clinics more than 35 miles from the main hospital. NCPA met with staff members from both congressional offices to raise our concerns.
NCPA Suggests NPI Revisions on FAST Act: This week NCPA sent to Senators Carper (D-DE) and Coburn (R-OK) suggested changes to the proposed FAST Act legislation. We are requesting that the legislative language state that any and all prescribers shall obtain an individual NPI number and shall affix that individual NPI number to all Part D prescriptions. This would mean that individual prescribers could no longer use group NPI numbers and that medical residents and interns could no longer use teaching physician NPI numbers. We also requested that the legislative language clearly state that the PDPs must bear ultimate responsibility for validating and verifying the NPIs on Part D prescription drug claims. We are further requesting that additional language state that PDPs shall hold harmless suppliers and providers who fail to submit claims with valid NPI numbers despite their good faith best efforts to obtain those numbers. As an alternative option, we are requesting all PDPs institute hard edits to reject claims with invalid NPI numbers at the point of sale.
Congressional Recess: Earlier this week the House and Senate members left Washington, D.C. for their summer recess. They will be home campaigning in their districts and states until September 6th. Please us this recess to contact them or drop by their local office to educate them about the negative potential impact of the Express Scripts merger and ask support for community pharmacy’s legislative priorities.
NCPA Congressional Visits: NCPA participated in Hill visits for the following Members of Congress this past week:
Rep. Janice Schakowsky (D-IL) Member of the Energy and Commerce Committee
Rep. Linda Sanchez (D-CA) Member of the Ways and Means Committee
Rep. Jim Jordan (R-OH) Chairman of the Republican Study Committee
Rep. Tom Graves (R-GA) Member of the Appropriations Committee
Rep. Don Young (R-AK)
Rep. Bill Pascrell (D-NJ) Member of the Ways and Means Committee
Rep. Joe Courtney (D-CT)
Rep. Mike Fitzpatrick (R-PA)
Rep. Jo Ann Emerson (R-MO)
Rep. Cathy McMorris-Rodgers (R-WA)
Rep. Henry Waxman (D-CA), Ranking Member of the Energy and Commerce Committee
Rep. Frank Pallone (D-NJ), Ranking Member, Energy and Commerce Health Subcommittee
Sen. Sherrod Brown (D-OH)
Sen. Roger Wicker (R-MS)
Sen. Pat Toomey (R-PA)
Sen. Tom Coburn (R-OK)
Sen. Mike Crapo (R-ID)
Sen. Joe Manchin (D-WV)
Sen. Saxby Chambliss (R-GA)
Sen. Scott Brown (R-MA)
Sen. John Thune (R-SD)
Sen. Richard Blumenthal (D-CT)
Sen. John Barrasso (R-WY)
Sen. Mike Lee (R-UT)
Thanks to Rep Young who sent a letter to the FTC this week!
NCPA Participates in CMS Meeting on NADAC Benchmark: This week NCPA attended the CMS stakeholder meeting organized to discuss the development of the National Average Drug Acquisition Cost (NADAC) Survey that could be used by state Medicaid programs to set pharmacy reimbursement. The NADAC would be based on monthly invoices provided by a sample of community pharmacies. The meeting was held in Baltimore at CMS headquarters. Attendees included both state and national pharmacy associations, PBM’s, government agencies, buying groups, Bio-Tech companies amongst others. A summary of how NADAC will be calculated and potentially used by states is attached.
NCPA Submits Comments to OPM on PBM Transparency in Multi-State Exchange Plans: NCPA submitted comments to the Federal Office of Personnel Management (OPM) regarding the need for PBM transparency in the multi-state plans in the state health insurance exchanges that will be administered by OPM. NCPA comments encouraged OPM to mirror the PBM transparency provisions that were included in the proposed HHS regulations to implement the individual state exchanges. NCPA comments also encouraged OPM to allow the participation of any willing pharmacy that accepts the terms of the contract and that has not been excluded from any state or federal program as well as urged OPM not to equate access to pharmacy services to access to mail order pharmacy.
HHS Releases Rules on Copay Waivers for Women’s Health Care Services: HHS released a rule regarding co-pay waivers for preventive women’s health care services. Such cost sharing will be prohibited for non-grandfathered health plans starting with plan years beginning on or after August 1, 2012. This includes contraception and contraceptive counseling. Women will have access to all FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling. The regulation does not impact abortifacient drugs. Moreover, group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services.
CMS Says No Medicare Part D Premium Increase in 2012: This week CMS announced that Medicare average prescription drug premiums will not increase in 2012. CMS also announced that more people with Medicare are receiving discounts on prescription drug costs and no-cost preventive services. New data indicates that 17 million people with Medicare have received free preventive services this year while 900,000 Medicare beneficiaries who hit the prescription drug donut hole have received a 50 percent discount on their prescription drugs. CMS also announced that the cost of the average Medicare prescription drug plan premium in 2012 will be about $30. The average premium in 2011 is $30.76.
NCPA to Gov Cuomo: Please Sign Bill Eliminating Mandatory Mail Order: NCPA sent a letter to New York Governor Andrew Cuomo (D), asking him to sign the bill that would prohibit the use of mandatory mail order programs in prescription drug programs in the state. The bill overwhelmingly passed the legislature several months ago, and is awaiting his signature.
NCPA Launches “Simplify My Meds” Program: This “turnkey” program provides NCPA members with tools, training, and support to help them implement a coordinated refill program in their pharmacy. In addition to providing members with a business opportunity, NCPA would like to track not only pharmacy participation, but patient involvement. This will help illustrate patient progress and better understanding of their medication and better overall adherence as a result of their participation in this coordinated refill program. The results of these findings will be an important component of community pharmacy’s overall advocacy efforts as we continue to show pharmacy’s value in improving patient outcomes while decreasing health care costs.
Oklahoma Board Approves “Dispose My Meds”: The Oklahoma Board of Pharmacy has recently approved NCPA’s Dispose My Meds program and plans a pilot program for the safe disposal of unused/unwanted/expired (UUE) medications in conjunction with the Association. The pilot program will allow Oklahoma in-state licensed pharmacies to establish a drop-off location in their pharmacy for UUE medications, and then dispose of them through the Disposemymeds.org program. NCPA will coordinate with the Board of Pharmacy on next steps.
________________________________________________________________________________________________________________________________________________________________
John M. Coster, Ph.D., R.Ph.
Senior Vice President, Government Affairs
Director, Advocacy Center
National Community Pharmacists Association (NCPA)
100 Daingerfield Ave
Alexandria, VA 22314
703-683-8200 X184 - office
571-214-3936 - cell
john.coster@ncpanet.org
National Community Pharmacists Association (NCPA)
Advocacy Center Update
Week Ending July 22nd, 2011
_____________________________________________________
Please Contact your Members of Congress to support:
H.R. 1971/S. 1058 (PBM Reform/McMorris Rodgers; Pryor-Moran),
H.R. 1946 (PBM Negotiations/Marino) and
H.R. 1936 (DME/Schock-Welch)
___________________________________________________________________________
NCPA Opposed to Proposed PBM Merger (Express Scripts and Medco): This week, Express Scripts (ESI) announced plans to purchase Medco. As a result, the Prescription Benefit Management (PBM) marketplace will become smaller, more consolidated and less competitive. Currently CVS Caremark, Express Scripts and Medco have over 80% of the PBM market for insured lives. This merger could give ESI almost 50% of the PBM market for insured lives, thus reducing competition for consumers.
This merger could have a significant impact on consumers not only in the private marketplace but also in federal programs like Medicare Part D, FEHBP, and TRICARE. Federal and state employee and retiree programs, in particular, should be troubled by this merger. For example, the Medicare Part D drug benefit is built on competition and approving this deal would undermine that foundation. We are currently looking into how many lives would be impacted in the Part D program. At the state level, increasing this market concentration could potentially increase the cost of their state employee and other health plans by significantly decreasing competition. Additionally, this proposed merger comes on the heels of the CVS-Caremark merger which the FTC approved and is now currently investigating.
Over the next few weeks, we will be developing a legislative and regulatory plan to strongly oppose this merger. We will be reaching out to consumer groups, payers, the FTC, Members of Congress, CMS, state legislators, Governors, the small business community and others who should all have concerns about the impact of this merger on consumers, health care costs, competition and small businesses.
Congressman Tom Marino (R-PA), lead sponsor of H.R. 1946 (the collective bargaining bill) released a statement the day the proposed merger was announced expressing his concerns over the merger and stating, “hometown pharmacies are already at a substantial disadvantage when it comes to negotiating with the PBMs. This merger could worsen the problem and ultimately lead to increased costs and decreased quality of care.”
We will need the active help of all NCPA members to oppose approval of this merger by the FTC!!! Expect materials very soon to help deliver this message.
Debt Limit Negotiations Continue: As of this writing, negotiations continue between Congressional Leaders over a package of cuts and possible revenue raisers that would raise the debt ceiling. The country reaches its debt limit in just over a week, and Medicare and Medicaid programs cuts are still on the table. NCPA sent a letter to all Congressional offices as well as the White House, outlining our concerns with some of the potential proposed reductions affecting pharmacy. These key messages included the following:
· Reducing Payments for Medicare Diabetes Testing Supplies will Hurt Patients: Reimbursements for diabetes testing strips are already low and lowering them further could cause many pharmacies to cease to offer these products. Seniors, particularly in rural and urban areas, rely on independent community pharmacists for the diabetic supplies, and in many cases, a community pharmacist is their only opportunity to speak face to face with a pharmacist and obtain necessary counseling to ensure they are properly using their supplies and correctly interpreting results.
· Medicaid Reductions Could Devastate Patient Care: State Medicaid programs are already under tremendous financial pressure and we are concerned that taking billions out of Medicaid and CHIP will make a bad situation worse. Steps such as limiting prescriptions, moving to mail order or reducing access to pharmacies will be harmful to Medicaid patients’ health care.
· Keep TRICARE Military Drug Benefits in Local Pharmacies not Out of State Mail: Shifting more TRICARE patients to mail order by increasing co-payments for TRICARE beneficiaries who prefer to obtain their prescriptions from a community pharmacy is not the way to save money. Rather than shift patients to wasteful mail order, TRICARE should partner with community pharmacies to increase generic dispensing and to maintain access to community pharmacies for beneficiaries.
IF YOU HAVE NOT DONE SO, PLEASE CALL YOUR SENATORS AND CONGRESSMEN AND PLEASE DELIVER THE MESSAGES ABOVE. THANK YOU!
Senate Aging Committee Releases Plan for Reducing Medicare Costs: This week, the Senate Aging Committee held a hearing on “A Prescription for Savings: Reducing Drug Costs to Medicare”. The Committee Chairman, Senator Herb Kohl (D-WI), released a plan for reducing costs in Medicare which includes NCPA’s endorsed PBM transparency provisions. Two key recommendations affecting community pharmacy are: 1) giving the government and employers access to transparent PBM data to better manage drug costs, which is also a priority of NCPA; 2) discouraging prescribing of controversial antipsychotic drugs for nursing home residents. The Chairman may seek to include some of these in the debt reduction talks.
Preserving Our Hometown Independent Pharmacies Act of 2011 (HR. 1946): NCPA continues to meet with Members of the Subcommittee on Intellectual Property, Competition, and the Internet, to urge Chairman Goodlatte to hold a hearing and markup of HR.1946 within the committee. The legislation would provide more leverage to independent pharmacies against PBM contracts. We are now circulating letters in the states of Texas and Virginia for pharmacists to sign that urges the Chairman of the Judiciary Committee (Rep. Lamar Smith-TX) and Subcommittee Chairman Goodlatte to support a hearing for this bill. If you live in one of these states please keep on the look-out for the request for a signature. It’s important that we have as much support as possible! This week, NCPA as well as representatives of the Association of Community Pharmacies Congressional Network met with Committee staff to talk about the bill and moving it forward. The announced ESI-Medco merger will give new momentum to the bill!
NCPA Met with the Following Congressional Offices: Senator Roger Wicker (R-MS), Senator Bob Corker (R-TN), Senator Mike Crapo (R-ID), Senator Boozman (R-AR), Congressman Pete Sessions (R-TX), Chairman of the National Republican Congressional Committee, Congressman Wally Herger (R-CA), Chairman of Ways and Means Health Subcommittee, Congressman Marino (R-PA. )
OIG Releases Study on State Medicaid Reimbursement Plans: This week the OIG released a study titled “Replacing Average Wholesale Price: Medicaid Drug Payment Policy.” The study was conducted to determine how States will set reimbursement for Medicaid prescription drugs after First DataBank stops publishing AWP in September 2011 and to determine the role that States would prefer CMS to play in developing reimbursement methodologies for prescription drugs. Of the 45 States that used AWP to set reimbursement for prescription drugs in the first quarter of 2011, 20 States did not have definitive plans for prescription drug reimbursement after First DataBank stops publishing AWPs in September 2011. Of the 45 States with AWP-based reimbursement methodologies, 3 had developed plans to replace AWP with AAC, 12 to replace AWP with WAC, and 10 to use AWP from a source other than First DataBank. Most States (44 of 51) would prefer that CMS develop a single national benchmark to set Medicaid reimbursement rates, and 24 of these States specifically wanted a benchmark based on pharmacy acquisition costs. NCPA will be attending a CMS hosted stakeholder meeting on August 4 to discuss methodologies that Myers and Stauffer will employ for a recently awarded contract to survey retail pharmacy prices and pharmacy drug acquisition cost information.
NCPA Submits Letter to CMS Regarding Oregon Medicaid: NCPA submitted a letter this week to CMS regarding the proposed Oregon State Plan Amendment that would change the thresholds for pharmacy dispensing fee tiers and reduce dispensing fees. The NCPA letter expressed grave concerns about the proposed State Plan Amendment to lower dispensing fees less than a year after CMS granted approval to transition pharmacy reimbursement to AAC, accompanied by an increased dispensing fee. NCPA also recommended that CMS provide official guidance to states regarding both: (1) initial proposals to transition to AAC and the need for an accompanying increase in pharmacy dispensing fee; and (2) subsequent proposals for a reduction in the pharmacy dispensing fee for states that have already transitioned to AAC.
NCPA Attends NCOIL: NCPA staff attended the National Conference of Insurance Legislators in Newport Rhode Island July 14-17. This organization is comprised of state representatives and state senators that either chair or hold leadership positions on state legislative committees that have jurisdiction over all insurance issues. This group is separate from the National Association of Insurance Commissioners although the two groups do collaborate on many initiatives. The NCOIL meeting included a full day symposium on state insurance exchanges. The symposium included presentations from Joel Ario from CCIIO as well as representatives from the existing Utah and Massachusetts health exchanges. There was also a panel discussion that included updates from some states that have received early innovator grants from the federal government to set up an exchange in their state. All speakers emphasized the fact that technology concerns would be an early challenge as well as ensuring continuity of coverage for those individuals whose eligibility thresholds may vacillate between Medicaid and the state exchange. NCOIL also has a standing committee that focuses exclusively on health insurance related issues. Committee staff indicated that they would be interested in examining PBM-related issues and plans have been made for future discussions between NCOIL staff and NCPA.
NCPA Meets with CMS Office of Program Integrity: NCPA met with the Center for Program Integrity at CMS to discuss the upcoming proposed rule on Part D Recovery Audit Contractor’s (RACs). We urged CMS to take the following suggestions under consideration in developing Part D RACs:
· Appropriately constrain and place limits on the Part C and D RAC contingency fee arrangements;
· Prohibit Part C and D RACs from using statistical extrapolation for determining recoupment amounts;
· Equally incentivize Part C and D RACs to pursue underpayments, as well as overpayments;
· Require Part C and D RACs to coordinate their auditing efforts with other auditors and for CMS to monitor and provide oversight over such coordination efforts;
· Adopt a series of audit best practices provisions designed to prohibit audit abuses and ensure a fair audit process for community pharmacies;
· Create an oversight board to approve or disapprove of Part C and D RAC proposals to pursue certain complex or borderline auditing cases; and
· Prohibit Part C and D plans from creating in-house RACs.
CMS advised us that the Part D RACs are going to be solely focused on plan sponsors and not pharmacies. They are also focused solely on overpayment and not fraud. Nonetheless, we remain concerned that auditing practices enforced upon the plan sponsors will trickle down to and impact pharmacies. However, CMS maintains that they cannot interfere with the auditing practices of the plan sponsors because of the Medicare Part D non-interference statutory provision. On the positive side, CMS notified us that any implemented in-house RACs would only be used in Part C and not Part D.
NCPA Attends White House Meeting on Drug Abuse: NCPA President Bob Greenwood represented NCPA in an ONDCP meeting to discuss the pharmacist's role in preventing prescription drug abuse. The stakeholder meeting was convened in response to action items laid out in the Administration’s Prescription Drug Abuse Prevention Plan. In the association’s comments, NCPA stated that as one of the most accessible and trusted health care providers, community pharmacists recognize the importance of addressing the serious problem of prescription drug diversion and abuse, and believes that community pharmacists are well-positioned to respond to the action items laid out in the prevention plan, particularly in the areas of education, tracking and monitoring, and proper disposal. To that end, NCPA launched a webpage this week dedicated to the prevention of prescription abuse, www.ncpanet.org/preventrxabuse. The homepage provides resources, tools, and educational materials for pharmacists and patients related to the topic of medication abuse and misuse.
Political Activities: NCPA staff attended political and fundraising events this week for: Sen. Jerry Moran (R-KS): Co-Chair of Senate Community Pharmacy Caucus; Rep. Pete Sessions (R-TX), who Serves on House Rules Committee and is Chairman of the National Republican Congressional Committee; and, Rep. Tom Marino (R-PA): Lead sponsor of H.R. 1946, The Preserving Our Hometown Independent Pharmacies Act
______________________________________________________________________________________________________________________________________________________
John M. Coster, Ph.D., R.Ph.
Senior Vice President, Government Affairs
Director, Advocacy Center
National Community Pharmacists Association (NCPA)
100 Daingerfield Ave
Alexandria, VA 22314
703-683-8200 X184 - office
571-214-3936 - cell
john.coster@ncpanet.org
National Community Pharmacists Association (NCPA)
Advocacy Center Update
Week Ending July 9th, 2011
_____________________________________________________
Please Contact your Members of Congress to support:
H.R. 1971/S. 1058 (PBM Reform/McMorris Rodgers; Pryor-Moran),
H.R. 1946 (PBM Negotiations/Marino) and
H.R. 1936 (DME/Schock-Welch)
___________________________________________________________________________
Medicaid Cuts on the Table at Debt Ceiling Talks: As debt ceiling discussions continue in Washington, rumors are circulating about those programs that may be cut, and by how much. Cuts to Medicare and Medicaid are on the table, but it’s not clear which policy approach may be adopted. For the Medicaid program, “block granting” appears to be off the table, but a new proposal called a “blended rate” appears to be gaining favor.
Here's how a blended rate might work. States receive Federal matching funds for their Medicaid and Childrens Health Insurance Program (CHIP) costs based on a specific matching formula for EACH program. However, under this blended rate approach, a state would receive a single new matching Federal percentage rate to pay for costs for its combined existing Medicaid population, its CHIP population and its Medicaid expansion populations which come on line in 2014. Currently, Federal Medicaid matching rates for states’ costs range from 50 to 75%, with a 57% average; CHIP matching rates are 70% on average; while the new Medicaid expansion populations will be covered initially at 100% by the Federal government, and then in the 90% to 95 % range after the first few years of the expansion.
Concerns exist that a new single blended matching rate would result in states receiving fewer Federal funds to pay for health care costs for these populations. That would result in a shift of some of the program costs from the Federal government to the states, which could mean provider cuts or benefit reductions. The Obama Administration is advocating for this “blended rate” proposal. Another option would require drug manufacturers to pay Medicaid rebates for drugs dispensed to Medicare Part D dual eligibles. Providers groups are gearing up to oppose proposals that would shift Medicaid costs back to cash-strapped states.
NCPA Supports Eliminating the Rx Requirement for FSA-reimbursed OTCs: NCPA expects U.S. Senators Pat Roberts (R-KS) and Ben Nelson (D-NE) to introduce legislation repealing the restrictions placed on tax-preferred accounts which reimburse over-the-counter (“OTC”) medications without a doctor’s prescription. NCPA is working with the Health Choice Coalition of physicians, consumers, retailers, manufacturers, patients, insurers, small businesses and employers on this important legislation. We plan to sign on to the coalition letter supporting the legislation in the Senate.
Preserving Our Hometown Independent Pharmacies Act of 2011 (HR. 1946): NCPA continues to meet with Members of the Subcommittee on Intellectual Property, Competition, and the Internet, to urge Chairman Goodlatte (R-VA) to hold a hearing and markup of HR.1946 within the committee. The legislation would provide more leverage to independent pharmacies against PBM contracts. We intend to circulate letters in the states of Texas and Virginia for NCPA members to sign that would urge the Chairman of the Judiciary Committee (Rep. Lamar Smith-TX) and Subbcommittee Chairman Goodlatte to support a hearing for this bill. If you live in one of these states please keep on the look out for the request for a signature in the coming weeks.
Medicare Access to Diabetes Supplies Act of 2011 (H.R. 1936): There are concerns that Congress may be considering including all retail pharmacies in the Medicare competitive bidding program for diabetes test supplies as part of the debt ceiling talks. NCPA submitted a letter this week to congressional leaders opposing any effort to move independent community pharmacies into competitive bidding for diabetic testing supplies or to reduce the fee schedule for diabetic testing supplies. We indicated our support for H.R. 1936, which would exclude smaller community pharmacies from the bidding program or from having to accept the competitively-bid price.
We will be asking you to reach out to your Member of Congress to oppose the inclusion of independent pharmacies once we get all the details. We are working the Reps. Schock and Welch on a Dear Colleague letter to circulate with other Congressional offices to gain co-sponsors.
Debit Card Interchange Fees (swipe fees): Earlier this week, the Federal Reserve issued the new regulations for debit card interchange fees. Below is a summary of main points:
· The regulation increased the fee cap from the 12-cents-per-transaction cap contained in the draft regulation to between 21 and 24 cents in the final version-twice the fee which was included in the draft reg. Currently the current average swipe fee is 44 cents;
· The regulation delays implementation to Oct. 1, 2011. Under the draft regulations the debit card restrictions would have begun on July 21, 2011;
· Merchant and consumer groups are both unhappy because the fees are higher than expected and there is no prohibition on raising other banking service fees so there is the likely threat that the banks and credit card companies will raise other fees to make up for the cuts to the swipe fees.
NCPA continues to review the new regulations and will determine if we will respond to the final regulations.
Political Activities: This week, NCPA met with Rep. Austin Scott (R-GA), President of the Freshmen class of the 112th Congress, Rep. Tom Marino (R-PA), Rep. Mike Rogers (R-MI), Rep. Eliot Engel (D-NY), Rep. Michael Grimm (R-NY), Rep. Bill Cassidy (R-LA), Rep. Devin Nunes (R-CA) and Rep. Mike Ross (D-AR).
CMS Awards Pricing Survey Contract to Myers and Stauffer: CMS announced that the accounting firm Myers and Stauffer has been awarded a contract to survey retail pharmacy prices and pharmacy drug acquisition cost information. The contract is titled “Survey of Retail Prices: Payment and Utilization Rates, and Performance Rankings.” Get ready for new alphabet soup in pharmacy reimbursement. The survey will produce two new sets of publicly-available pharmacy pricing information:
· Retail Survey Price (RSP) which will be a compilation of the prices (reimbursement) received by pharmacies for covered outpatient drugs, known as “consumer purchase prices.” In theory, this is the average “out the door” price the pharmacy receives for a particular drug. As we understand, the price would be a blend of commercial payers, Medicaid (maybe), and cash prices, with only retail pharmacy prices included. Mail order and LTC prices would be excluded. This would give states a sense of how much a pharmacy is receiving from non-Medicaid payers as compared to Medicaid.
· Actual Acquisition Cost (AAC) is supposed to be based on a “voluntary” survey of pharmacies to determine retail pharmacy purchasing costs for drugs. It is assumes that the contractor will ask pharmacies to provide their invoices so it can determine an AAC. However, it is not clear how granular this survey will be. It sounds like the contractor will publish AACs for brands and generics, but will it publish an AAC for each manufacturer’s generic or a weighted average across all manufacturers of that particular generic drug? It is not clear whether or how CMS will treat LTC pharmacies in this survey, although the information provided so far indicates that AAC will be based on independent, chain and specialty pharmacies. It is also not clear if CMS will publish an AAC for each separate class of pharmacy. Finally, it is not clear that CMS has the actual legislative authority to publish an AAC file. NCPA has sent several communications to CMS since the concept of a survey was floated to question the agency’s ability to publish these data. CMS has made it clear they want stakeholder input in design of the survey, however.
According to CMS, the purpose of the Survey of Retail Prices is to develop a monthly survey of retail community pharmacy prescription drug prices and the generation of publicly available pricing files. CMS anticipates that the files will give State Medicaid agencies an array of covered outpatient drug information, regarding retail prices for the ingredient costs of prescription drugs and consumer purchase prices for such drugs. CMS expects Medicaid agencies will use this information to compare their own pricing methodologies and payments to those derived from the survey. Additionally, on an annual basis, CMS will obtain from the State Medicaid agencies information on their prescription drug payment and utilization rates and prepare a comparative report regarding the performance of the States' reimbursement prices and the national retail price data collected in the survey.
In addition to RSP and AAC data, states will also recieve weighted average AMP data for muiltiple source drugs. CMS has not indicated when such data will be made public, although it is likely tied to the publication of the final rule on AMP, which has not yet even been published as a proposed regulation. Weighted AMP is the average price (based on utilization) paid to the generic manufacturers by wholesalers (including chain warehouses) for a particular dosage form and strength of a multiple source drug distributed to community retail pharmacies. Weighted AMPs will only be made public for multiple source drugs. Weighted AMP will be used to set FULs when a final CMS regulation is published.
CMS Delays Implementation of Infusion Drug Policy Change: CMS released a notice on July 1 that delays implementation of the policy clarification surrounding billing of drugs furnished incident to a physician service to August 15, 2011. The notice clarifies that pharmacies may not bill Medicare Part B for drugs dispensed directly to a beneficiary for administration "incident to" a physician service, such as refilling an implanted drug pump. When drugs are administered in the physician's office to a beneficiary, the only way these drugs can be billed to Medicare is if the physician purchases the drugs from the pharmacy. NCPA understands that some pharmacies are billing the Part B carrier directly for the drugs and the physician bills for the service of refilling the pump. NCPA has been coordinating with both the National Home Infusion Association and the International Academy of Compounding Pharmacists and will continue to gain feedback from our membership about the impact of this policy clarification on their daily practice and the needs of their patients.
GAO Report on Competitive Bidding at Manufacturer Level: The GAO released a report outlining options for Congress to consider if it wanted to do competitive bidding for DME at the manufacturer level instead of the supplier level. CMS would leverage its purchasing power at the manufacturer level to reduce prices, instead of at the supplier level. The report looked at how the VA, Medicaid and some group purchasing organizations operate in negotiating prices with manufacturers. The GAO found that CMS would have to address some of the same issues it faces with the supplier level CBP, plus some new ones. There do not appear to be any plans in place to implement this proposal.
CMS Announces Changes to DME Billing Practices: Starting August 2, 2011, DME supplies provided on a recurring basis must be billed prospectively, not retrospectively. This means that a supplier cannot deliver a supply, wait to see how much is used and then bill for the used portion at the end of the month. The supplier must bill for the full amount supplied and must bill at the beginning of the month. Moreover, for refilled DME supplies, the supplier must contact the beneficiary prior to dispensing the refill and not automatically ship on a pre-determined basis, even if authorized by the beneficiary. Contact with the beneficiary must occur 14 days or fewer before the delivery date. Delivery of the refill must occur 10 days or fewer before the end usage of the current product.
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John M. Coster, Ph.D., R.Ph.
Senior Vice President, Government Affairs
Director, Advocacy Center
National Community Pharmacists Association (NCPA)
100 Daingerfield Ave
Alexandria, VA 22314
703-683-8200 X184 - office
571-214-3936 - cell
john.coster@ncpanet.org