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Congress’ plan for Medicaid payment doesn’t go far enough, NCPA charges


WASHINGTON New health reform proposals being mulled in Congress contain some pharmacy-friendly concepts but don’t go nearly far enough to address the impasse over low Medicaid prescription payments, the independent pharmacy lobby charged Tuesday.

That charge came in reaction to a “discussion draft” of healthcare reform legislation released by the House Education and Labor, Energy and Commerce, and Ways and Means Committees. The airing of the draft marked an early step in what likely is to be a long and contentious legislative process over the summer, as Democrats and Republicans wrestle over plans for the biggest change to the U.S. healthcare system in decades.

Nevertheless, the National Community Pharmacists Association already is raising concerns over elements in the proposed legislation that would keep the basic structure of the current Medicaid pharmacy payment system intact. “We’re grateful that [the congressional panels] recognized the need to change the flawed rule that will pay pharmacies on average 36% below their acquisition cost for Medicaid pharmacy generic prescription drug reimbursements using an average manufacturer price formula,” said NCPA EVP and CEO Bruce Roberts. “Unfortunately, the fix does not go far enough.”

In particular, Roberts told lawmakers, “the discussion draft's 130% of weighted average AMP still dramatically underpays pharmacies below the product acquisition cost. As a result, too many community pharmacies would still be forced to limit or even leave the Medicaid program. That limits patient access, which is not a desirable outcome for anyone interested in keeping these patients healthy,” he added.

Independent pharmacy also has other concerns as Congress mulls health reform, said Roberts. Among them, he noted, is a strong belief “that health insurance plans, including any new government-sponsored plan, should offer medication therapy management services that maximize patient outcomes with prescription drugs. We also urge inclusion of H.R. 616 and H.R. 1970, which would exempt pharmacies from unwarranted bureaucratic hurdles to the selling of durable medical supplies, such as diabetes testing strips.

“Finally, we believe that the disclosure of the financial relationship between manufacturers and the administrators of prescription drug plans -- pharmacy benefit managers -- is critical to reducing costs that can be passed onto consumers," Roberts added. "At the end of the day, real reform needs to control the exploding costs of health care, and this is one way of ensuring that occurs.”

Roberts acknowledged that “this is just one of the first steps in the House process and that changes to the bill are likely. We also empathize with members of Congress facing extraordinarily tight budget constraints.” NCPA staff, Roberts said, “will continue working with lawmakers to find solutions for the reimbursement of Medicaid generic drugs and other issues that allow independent community pharmacies to continue providing critical access to their patients.

“We’re hopeful that, once the legislative process runs its course, the final bill will reflect that admirable goal,” Roberts said.

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