NCPA To Congress: Health Reform Should Empower Community Pharmacies To Improve Patient Outcomes, Reduce Costs

Main Category: Pharmacy / Pharmacist
Article Date: 26 Jun 2009 - 4:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

National Community Pharmacists Association (NCPA) Executive Vice President and CEO, Bruce T. Roberts, RPh testified today before the U.S. House Energy and Commerce Subcommittee on Health, offering four different recommendations to strengthen a health care reform proposal currently working its way through Congress.

NCPA has been working to ensure that community pharmacies can continue providing valuable health care services to millions of patients and to explain how pharmacies can be at the forefront of improving health outcomes and driving down costs. What follows are key excerpts from Roberts' testimony on a "discussion draft" proposal released June 19th:

Incorporate Pharmacists' Services into a Reformed Health Care System

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

"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 (MTM) 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."

Fix Medicaid Pharmacy Reimbursement System

"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. "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.

"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 FUL reimbursement rate for generic medications, especially for critical access pharmacies that serve a higher percentage of Medicaid recipients, or rural pharmacies. We also ask that the language include a requirement that states set dispensing fees based on recent cost of dispensing surveys to assure that pharmacies can continue to dispense Medicaid generic prescriptions and keep their doors open."

Modify Pharmacy DMEPOS Accreditation Requirements

"We believe that requiring state-licensed, state-supervised community retail pharmacies to obtain both accreditation and surety bonds to sell simple DMEPOS items such as diabetes testing supplies to Medicare beneficiaries is basically overkill.

"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…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."

Assure Efficient Operation of Public Health Insurance Plan Option

"Under the House proposal, payment rates for prescription drugs under the public plan proposal would be negotiated by the 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

"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 (PBA) rather than a pharmacy benefits manager (PBM). That is because under a PBA, most if not all negotiated drug manufacturer rebates would be passed through to the public program.

"The public plan would also benefit because 'spread pricing' would be eliminated. 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.

"With respect to any public plan option established, we also ask that standards be established for payment rates to pharmacies, including the establishment of dispensing fees, and that "any willing pharmacy" be allowed to participate in a public plan option if it is developed."

To view the entire testimony, click here.

Source
National Community Pharmacists Association