Handing pharmacy a key victory, House okays AMP delay, ‘prompt pay’


WASHINGTON In a major victory for pharmacy hailed by a gamut of retail and professional groups, the U.S. House of Representatives today passed, by an overwhelming margin, legislation to delay the rollout of new Medicaid prescription reimbursement cuts and to push for faster payment of Medicare Part D drug claims.

The bill, known as the Medicare Improvements for Patients and Providers Act of 2008 or H.R. 6331, would also suspend a plan by the Bush administration to require pharmacies to enter a competitive bidding program in order to continue selling durable medical equipment, prosthetics, orthotics and supplies to patients enrolled in the Medicare Part B program.

If passed by the Senate and signed into law by Pres. Bush, H.R. 6331 would mark a critical turning point in the often thorny relationship between federal policymakers and community pharmacy. Its passage in the House—by a veto-proof margin of 355-59, with 129 Republicans voting for final passage and 59 against, already marks a fundamental breakthrough in the retail pharmacy industry’s long battle for greater recognition and fair payment from the powers in Washington.

Among the bill’s many pharmacy-friendly provisions, it would:

  • postpone, until Oct. 1, 2009, implementation of the new AMP-based pharmacy payment plan for generics dispensed under Medicaid.
  • mandate a 14-day reimbursement cycle for Medicare Part D claims paid by prescription drug plans.
  • require weekly updates of posted Medicare prescription drug prices.
  • delay the rollout of Round 1 of the new competitive bidding requirement for DEMPOS under Medicare Part B.

Retail pharmacy leaders were ecstatic. The National Association of Chain Drug Stores, the National Community Pharmacists Association, the Food Marketing Institute and the American Pharmacists Association were unanimous in their praise of House Ways and Means Committee chairman Charlie Rangel, D-N.Y., and House Energy and Commerce Committee chairman John Dingell, D-Mich., for their support of the bill, and their efforts to load it with provisions supportive of retail pharmacy.

“This is a huge victory for community pharmacy and sends a strong message to the Senate and the White House,” noted NCPA in a statement. “NCPA worked closely with the House leadership to move this bill to a vote.”

“We are delighted by the size of the vote, which demonstrates tremendous bipartisan support,” said NACDS president and chief executive officer Steve Anderson. “It reflects the realization that this bill is important to healthcare and the nation’s economy.”

In a letter to Rangel and Dingell, Anderson hailed their efforts. “We thank you for your leadership on these issues and pledge to work with you to see that this bill is enacted into law this year,” he wrote. “By delaying billions in Medicaid payment cuts to retail pharmacies—the so-called AMP cuts—your bill will prevent pharmacies from facing the untenable situation of having to accept below cost payments when serving low-income patients.”

Also weighing in was John Gans, APhA’s executive vice president and chief executive officer. “APhA commends the House of Representatives for taking this important step to improve access to pharmacist services,” Gans said. “Patients are counting on Congress and the President to enact this legislation.”

Also sending a strong endorsement was Cathy Polley, vice president of pharmacy services for FMI. “This vote is a victory for low-income families across America,” Polley said. “A delay would give Congress an opportunity to legislate a reimbursement formula that preserves pharmacies that serve the neediest Americans.”

Not surprisingly, the pharmacy benefit management industry voiced opposition to some aspects of the bill. According to a statement today from the Pharmaceutical Care Management Association, policymakers confronting changes to Medicare “face the decision of either supporting costly Medicare ‘prompt pay’ requirements for pharmacies or postponing the average manufacturer price pharmacy reimbursement cuts in Medicaid.”

The PCMA joined a broad coalition of pharmacy groups in urging Congress to delay the AMP-based Medicaid reimbursement cuts to pharmacies. But the group is strongly opposed to a prompt-pay mandate, arguing that its members already pay Medicare prescription claims within a reasonable and customary 30-day time frame.

“Now that we’re in the endgame, Congress must choose between a reasonable AMP delay and a new policy to pay drug stores twice as fast as every other Medicare provider,” asserted PCMA president and chief executive officer Mark Merritt. “Delaying AMP is supported by a broad coalition of pharmacists, PBMs, and insurers. ‘Prompt pay’ has no such support and would undermine the affordability and integrity of the Medicare program.”

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