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NASHVILLE, Tenn. — Wrapping up its 113th Annual Convention and Trade Exposition, the National Community Pharmacists Association on Tuesday outlined the association's key initiatives and programs heading into 2012. Chief among the association's concerns are threats to already-diminutive reimbursement rates for prescriptions filled, including the release of federal upper limits by the Centers for Medicare & Medicaid Services.
"Our analysis leads us to be very concerned with the initial release of this information and we will be talking more with CMS and sharing our strategy for asking them to reconsider how they calculated those figures," NCPA's EVP and CEO Doug Hoey told reporters during a media conference call.
In a Sept. 2 newsletter, NCPA explained that the White House Office of Management and Budget has extended its review of the Medicaid AMP regulation, which will delay implementation of the AMP regulation. "However, NCPA continues to hear numerous complaints from pharmacists regarding state Maximum Allowable Costs for Medicaid generics that are much lower than their acquisition cost. That is because state MACs are based on the Federal Upper Limits for generics — which are set by CMS – but haven’t been updated in several years. … CMS is waiting for the new authority in this now delayed new AMP regulation – the final version of which may be many months away – before updating the FULs to reflect current market prices."
The proposed merger between Express Scripts and Medco is also expected to threaten reimbursement rates. Already one pharmacy in rural Colorado has been dispensing an ESI prescription for Humera (adalimumab) at a $43.40 deficit. According to Don Colcord of Nucla’s Apothecary Shoppe in Nucla, Colo., his acquisition cost for the rheumatoid arthritis treatment is $1,765.23 versus a reimbursement of $1,721.83. His patient, who doesn't have another pharmacy option in a 100-mile radius, does not want to participate in mail order out of concern that the temperature-sensitive medication might go bad if not delivered in a timely fashion.
Beyond reimbursement challenges, the business of independent pharmacy looks positive, Hoey said. "We see the opportunities for community pharmacy to continue to expand their role in the healthcare system." Those opportunities include improved medication adherence — a major theme that resonated throughout the meeting, Hoey said. "We have a program that we released a couple of months ago called Simplify My Meds," he said. "We believe that adherence is one of those issues that aligns the interests of the healthcare system, patients, payers and pharmacists and that pharmacists are in an ideal position to be able to influence and improve patient outcomes through adherence."
Some of the announcements to come out of the meeting included an independent pharmacy hotline number that was established by SureScripts to address concerns and issues around e-prescribing. NCPA also established the NCPA Legal Resource Center, a legal library that community pharmacists considering legal action of any sort can consult. And NCPA expanded its marketing and merchandising support for independent pharmacists with the hiring of consultant Gabe Trahan, director of retail services for Burlington Drug Co., to help independents better monetize their front-end.