Pharmacy groups emerge victorious as Congress overrides Medicare veto

WASHINGTON Retail pharmacy won a major victory yesterday when the U.S. Senate and House of Representatives both voted overwhelmingly to override President Bush’s veto of H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008. By that vote—a sharp rebuke of the President’s support for Medicare cost cuts in his waning days in office—the pharmacy-friendly bill has become law.

Passing in the House of Representatives 383-41 and Senate 70-26, the override ends what, as reported by Drug Store News, has been weeks and months of stops and starts for a bill that greatly benefits pharmacy and promotes patient access to health care. “This is a watershed day for pharmacies and patients,” said National Association of Chain Drug Stores’ president and chief executive officer Steve Anderson, “By enacting not one, but four, top pharmacy priorities, Congress has demonstrated that it understands the value of patient-pharmacy relationships and the importance of maintaining access to medications and pharmacy services.”

“Most critical among the pro-pharmacy measures,” noted the NACDS last night, “is one that delays implementation of drastic Medicaid pharmacy reimbursement cuts until September 2009.” Based on the so-called AMP rule enacted by the Centers for Medicare & Medicaid Services, which would use the average manufacturer price to determine Medicaid reimbursements for pharmacies, the cuts would likely have resulted in the closing of a potential 11,000 pharmacies, NACDS estimated. Especially in rural and urban areas in which many residents are Medicaid recipients, reimbursing pharmacies below cost for Medicaid prescriptions would have forced them to close.

“By delaying the average manufacturer price provisions, this legislation will ensure that patients struggling with their prescription drug costs will not be harmed in the process,” said Generic Pharmaceutical Association president and chief executive officer Kathleen Jaeger, upon the Senate’s passing of the bill last week. “Providing Congress with more time to create a fair and rational reimbursement system for retail pharmacies participating in the Medicaid program is critical to ensuring patients have the medicines they need.”

H.R. 6331 contains a number of other pro-pharmacy measures, as Anderson mentioned. In addition to the AMP delay, the legislation:

• Ensures prompt payment, with a 14-day turnaround, for reimbursement claims for Medicare Part D prescriptions, easing cash flow problems for smaller pharmacy operators.
• Postpones the rollout of the competitive bidding program for durable medical equipment under Medicare Part B. The delay, noted NACDS, “will provide the time necessary to ensure that Medicare beneficiaries fully understand the program and that there are a sufficient number of suppliers to ensure that access to durable medical equipment, such as diabetes supplies, is not disrupted.”
• Encourages the faster adoption of electronic prescribing in Medicare through financial incentives to physicians.
• Forestalls reimbursement cuts to physicians for services to Medicare patients.

It was the final point on which the President’s veto stood, as the bill prevents a planned 10.6 percent cut to physicians’ fees by instead reducing payments to private insurance plans. “It is fiscally irresponsible, and it would imperil the long-term fiscal soundness of Medicare by using short-term budget gimmicks that do not solve the problem,” the President’s message to the House read. “The result would be a steep and unrealistic payment cut for physicians—roughly 20 percent in 2010—likely leading to yet another expensive temporary fix; and the bill would also perpetuate wasteful overpayments to medical equipment suppliers.”

Regardless, the pro-pharmacy lobby won out handily. “I would like to thank the members of NACDS for making their voices heard in Congress on these pivotal issues,” said Anderson. “We are grateful for the leadership of Senate Finance chairman Max Baucus, D-Mont., House Energy and Commerce chairman John Dingell, D-Mich., House Ways and Means chairman Charles Rangel, D-N.Y., and Rep. Frank Pallone, D-N.J. We’d also like to thank the many Republican lawmakers who put the needs of patients first, helping to reduce long-term healthcare costs, and taking the tough vote to support this important legislation. Their commitment to enacting pro-pharmacy legislation has made this an extraordinary victory for our nation’s healthcare.”

Also hailing the legislative victory was John Gans, executive vice president and chief executive officer of the American Pharmacists Association. “APhA applauds Congress for its bipartisan efforts to better ensure patient access to pharmacist services and to vital medications,” Gans said today.

The National Community Pharmacists Association’s executive vice president and chief executive officer, Bruce Roberts, said passage of H.R. 6331 “will guarantee community pharmacies the ability to help millions of patients and to compete on a level playing field,” adding, “America’s 23,000 community pharmacies have just been given the prescription for success in the healthcare marketplace.”