Tamper-proof Rx pad deadline prompts appeal

ALEXANDRIA, Va. —With an Oct. 1 deadline looming for the nation’s physicians and pharmacists to switch to tamper-resistant prescription pads for Medicaid patients, the National Association of Chain Drug Stores has issued an urgent 11th-hour appeal to Congress to delay the new rule.

The industry group issued its appeal in a Sept. 11 letter from NACDS president and chief executive officer Steve Anderson to leaders of the U.S. House of Representatives, including Speaker Nancy Pelosi, D-Calif., and John Dingell, D-Mich., chairman of the House Energy and Commerce Committee. Anderson asked for immediate action to delay the required use of tamper-resistant paper for all Medicaid prescriptions as part of the upcoming “continuing resolution” or any other legislation that Congress passes prior to the Oct. 1 deadline mandated by Congress.

“We’re basically pursuing every angle we can at this point,” an NACDS spokeswoman noted.

The new rules were enacted as part of the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007, which contained language directing the Centers for Medicare and Medicaid Services to require use of the new tamper-proof pads by Oct. 1. Apparently, little thought was given to the problems that could arise in adopting tamper-proof pads.

NACDS, the National Community Pharmacists Association, the Food Marketing Institute, the American Society of Consultant Pharmacists and other pharmacy groups have expressed alarm about the short time allotted for such a broad-scale transition in how prescriptions are written, as have scores of physician and healthcare organizations.

Several members of Congress have taken up the cause, cosigning a letter to the House Committee on Energy and Commerce and the Subcommittee on Health urging congressional action to push back the implementation date to ensure that physicians have enough time to incorporate the new pads.

In his appeal, Anderson said delaying the deadline is critical to maintaining medication services to Medicaid patients. “Such a delay would provide the time necessary to make prescribers aware of the requirement, determine whether a sufficient number of tamper-resistant prescription pads will be available, ascertain how pharmacies are to recognize the various prescription forms as compliant, and educate pharmacists on what action should be taken if a prescription is not written on tamper-resistant paper,” he wrote.

A handful of states, including New York, already require physicians to use tamper-resistant pads. But rolling out a national system within the tight, two-month time frame allotted by Congress in the Iraq funding bill was never a real possibility, physician and pharmacy advocates contend.

John Motley III, senior vice president of government and public affairs for the Food Marketing Institute, told Drug Store News Sept. 13 that Max Baucus, chairman of the Senate Finance Committee, had told him in August that he shared pharmacy’s concern over the unworkable deadline for implementing the tamper-proof regulation. However, Motley was told, the new policy gained momentum after the Congressional Budget Office determined that any delay in implementing the new rule would cost the government money.

“The problem is that when Congress passed this, CBO scored this as a savings—probably because there would be less fraud involved in the filling of prescriptions…[for] Medicare and Medicaid,” explained FMI’s government affairs chief.

Baucus told Motley that “a revenue offset was needed” in order for Congress to pass legislation delaying the tamper-proof pad deadline. “He said they would find the revenue offset to delay it,” Motley said. Both Baucus and Iowa Sen. Charles Grassley, the ranking Republican on the Senate Finance Committee, “understand the problem of implementing this on the schedule that’s laid out, and at the very least, believe that we need more time to get it done,” he added. “So I think [Baucus] is going to act on it.”

Baucus indicated he would seek a six-month delay, Motley added.

Another hopeful sign, said Cathy Polley, newly appointed vice president of pharmacy for FMI, is that “the National Association of State Medicaid Directors has now gotten vocal and engaged, as well” in the Rx pad issue.

“They, too, can’t understand how this can possibly be implemented and work well for the Medicaid recipients on Oct. 1,” Polley told Drug Store News.

Motley described the change to tamper-proof pads as “a very good, logical thing to do,” provided enough time is given to shift physicians and pharmacies to the new system.