Some Senators Call For CMS To Increase Regulation Of Medicare Drug Plans

Main Category: Medicare / Medicaid / SCHIP
Article Date: 21 Jul 2006 - 2:00 PDT

email to a friend   printer friendly   opinions  

Senate Finance Committee Chair Chuck Grassley (R-Iowa), ranking committee member Sen. Max Baucus (D-Mont.) and a bipartisan group of senators this week sent a letter to CMS Administrator Mark McClellan to promote efforts that the senators say would encourage community pharmacies to participate in the Medicare prescription drug benefit and help improve Medicare beneficiaries' access to medications, CQ HealthBeat reports. In the letter, the senators urge McClellan to use CMS' authority to require Medicare prescription drug plans to provide pharmacists with lists of the plans' maximum allowable costs and prices. According to the senators, it is difficult for pharmacists to determine what reimbursements they will receive if they do not have the information. The senators also urge CMS to require drug plans to update average wholesale price lists every day and to give pharmacies the option of receiving payments through electronic funds transfers. In addition, CMS should review pharmacies that attempt to limit the frequency of beneficiaries' prescription refills and should work to ensure that drug plans allow long-term care facilities to fill prescriptions on an emergency basis, the senators write. "We strongly encourage the agency to examine PDP activities that may undermine beneficiaries' access and to consider the suggestions we offer to promote strong and continued participation of local, community pharmacies in the Medicare prescription drug plan," the letter states. CMS spokesperson Peter Ashkenaz said access to community pharmacies is "a CMS standard that we will continue to advance," adding that the agency will "remain vigilant" to ensure that prior authorization requirements do not disrupt beneficiaries' ability to obtain medications (Carey [1], CQ HealthBeat, 7/18).

PCMA Study
Legislation that would require Medicare drug plans and pharmacy benefit managers to pay claims from pharmacists within a certain time frame would increase Medicare costs by $55 billion over 10 years and would increase beneficiaries' cost sharing and premiums by $30 billion over the same period, according to a study released on Tuesday by the Pharmaceutical Care Management Association, a group that represents PBMs, CQ HealthBeat reports (Carey [2], CQ HealthBeat, 7/18). Groups representing independent pharmacists have called for passage of legislation (S 2563/HR 5182) that would require health plans to offer electronic payments and to provide payment within 14 days. Pharmacist groups have complained that payments from PBMs -- which operate under CMS-approved contracts with pharmacies -- are too slow for community pharmacists to cover their expenses (Kaiser Daily Health Policy Report, 6/27). The PCMA study analyzes the cost of the House bill, which is sponsored by Reps. Marion Berry (D-Ark.) and Walter Jones (R-N.C.). In addition to the prompt-pay requirements, the bill would require a minimum $14 dispensing fee for generic drugs dispensed at retail pharmacies and would institute new policies for medication therapy management by pharmacists. PCMA President Mark Merritt said that the bill "would undermine the very competitive forces that have resulted in deep discounts and lower-than-expected premiums," adding, "The legislation might enrich pharmacies, but it would also force seniors to pay billions of dollars more in higher premiums, cost-sharing and out-of-pocket costs" (Carey [2], CQ HealthBeat, 7/18).

The study is available online. Note: You must have Adobe Acrobat Reader to view the study.

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

• Additional
• References
• Citations