Independent pharmacy lobby testifies, seeking broader role in health reform

6/25/2009

WASHINGTON Community pharmacists stand ready to help lead the nation out of the morass surrounding the fractured U.S. healthcare system, the independent pharmacy lobby told Congress Thursday in an urgent appeal for a larger role in health reform efforts.

That appeal came from Bruce Roberts, EVP and CEO of the National Community Pharmacists Association. Testifying before the U.S. House Energy and Commerce Subcommittee on Health, Roberts offered four recommendations to strengthen a health care reform proposal currently working its way through Congress.

All four proposals would strengthen the role of retail pharmacies in a reformed health care system. They would also empower community pharmacies to improve health outcomes and wellness for millions of patients, while reducing the nation’s staggering health care price tag, Roberts told lawmakers.

In his testimony, NCPA’s top manager proposed a set of recommendations that mirrored comments he made in recent days, following the release on June 19 by House members of a “discussion draft” of health reform legislation. Among the points he made in Thursday’s testimony was one fundamental appeal: that Congress Incorporate pharmacists’ services into a reformed healthcare system when drafting health-overhaul legislation.

“The draft House language appears to allow the involvement of non-physician practitioners – such as pharmacists – in the medical home pilot project,” Roberts told panel members. “We recommend that this language be clarified and strengthened to make it clear that pharmacists should be included.”

In addition, he said, “We also believe that health insurance plans offered under the exchange should provide a comprehensive pharmacy benefit, rather than just a prescription drug benefit. This pharmacy benefit would include prescription drugs plus pharmacist-delivered medication therapy management services. These MTM services would be provided for select individuals who take a certain number of medications for chronic illnesses, have multiple chronic medical conditions, and incur a certain level of high prescription drug spending each year.”

Roberts also called on members of the subcommittee to fix a Medicaid pharmacy reimbursement system that he says is jeopardizing the livelihoods of independent pharmacy owners and access to community pharmacies by low-income patients.

“NCPA very much appreciates the fact that the draft House language includes reforms to the  Average Manufacturer Price [AMP]-based reimbursement system for Medicaid generic drugs,” Roberts told the panel. However, he added, “We are concerned that Medicaid generic drug reimbursement at 130% of the weighted average AMP as proposed in the draft House bill, combined with the low dispensing fees paid by states, will, in total, still significantly underpay pharmacies for dispensing low-cost generic drugs in the Medicaid program.”

Indeed, said Roberts, “Reimbursement at anything less than 150% of the weighted AMP will mean that independent community pharmacies are selling their products at a loss under Medicaid. NCPA asks that the committee consider a higher…reimbursement rate for generic medications, especially for critical access pharmacies that serve a higher percentage of Medicaid recipients, or rural pharmacies.”

The independent pharmacy lobby also wants to relieve community pharmacies of new rules that will require them to obtain both accreditation and surety bonds to continue selling Medicare Part B Durable Medical Equipment, Prosthetics, Orthotics and Supplies. Set to take effect Oct. 1, the new rules will govern even the sale of simple such DMEPOS items as diabetes testing supplies to Medicare beneficiaries.

Roberts called that new requirement “basically overkill” for licensed pharmacies. “While we understand the need to assure Medicare program integrity, thousands of pharmacies across the country – mostly small pharmacies – will not be accredited at all or not have finished the DMEPOS accreditation process by October 1st – which will mean they will not be able to provide diabetes testing supplies to Medicare beneficiaries,” he testified. “Disrupting their source of supply of diabetes testing supplies could result in less frequent blood glucose monitoring and higher costs for hospitalizations and physician visits.

“If there is a willingness to exempt pharmacies from these requirements, we ask that Congress consider acting before October 1st, which is the deadline for providers to attain accreditation and surety bonds.”   

Finally, NCPA’s chief addressed proposals by the Obama Administration to create a federally operated public health insurance plan as a coverage option for Americans seeking the most cost-effective health coverage. Such a plan should include protections to assure adequate payment rates and dispensing fees for participating pharmacies, Roberts urged – along with operating principles that assure that the government is purchasing drugs and other medical supplies cost-effectively on behalf of patients and taxpayers.

“Under the House proposal, payment rates for prescription drugs under the public plan proposal would be negotiated by the [Health & Human Services] secretary. We would be very concerned with giving authority to set payment rates for prescription drugs to the secretary without some basic guidance as to how these rates should be established and updated,” he noted. “We also ask that the language be clarified such that administration of any drug benefit under a public plan would be accomplished by a pharmacy benefits administrator rather than a pharmacy benefits manager. That is because under a PBA, most if not all negotiated drug manufacturer rebates would be passed through to the public program.”

In short, said Roberts, “The public plan option should fully benefit from any rebates or discounts paid by manufacturers or pharmacies, and not have part of these retained by a PBM intermediary.”

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