Royce C. Lamberth, United States District Judge, signed Court Orders to POSTPONE AMP as well as to POSTPONE posting of AMP on a public website stating: "Defendents' (CMS) actions are likely to cause Plantiff's (NACDS and NCPA) to suffer irreparable harm for which no adequate remedy at law exists as Plantiff's members will not be able to recover from the Defendants if the AMP rule is implemented, and thousands of Plantiff's members pharmacies are expected to be forced to reduce hours and services, forced out of the Medicaid program, or forced to close." Please read the full 3 page Court Order.
Special thanks to Tobey Schule, RPh for sharing this information with us.
Thursday, December 20, 2007
Saturday, December 15, 2007
NACDS Press Release...CMS will not be permitted to post AMP data on the Internet.
NACDS Press Release
FOR IMMEDIATE RELEASE
December 14, 2007
Contact: Chrissy Kopple, NACDS(703) 837-4266
John Norton, NCPA(703) 600-1174
Initial Victory for NACDS, NCPA in Lawsuit to Protect Low-Income Patients' Access to MedicationsJudge Grants Injunction Preventing CMS from Implementing Reimbursement Cuts, Posting Flawed AMP Data
Alexandria, VA - The National Association of Chain Drug Stores (NACDS) and the National Association of Community Pharmacists (NCPA) received an initial victory in their legal strategy to prevent Medicaid pharmacy reimbursement cuts. On the preliminary injunction motion filed by the groups on November 15, the United States District Court for the District of Columbia put the brakes on efforts by the Centers for Medicare and Medicaid Services (CMS) to impose Medicaid pharmacy reimbursement reductions scheduled to be implemented next month, and hamper access for low-income patients' to medications.
Judge Royce Lamberth ruled today that CMS will not be permitted to post data on the Internet related to the average manufacturer price (AMP) of generic pharmaceuticals. Nor will Medicaid reimbursement cuts take effect before Judge Lamberth has had an opportunity to fully review and make a final decision the merits of the lawsuit.
NACDS and NCPA filed a lawsuit against CMS and the U.S. Department of Health and Human Services, as well as, in their official capacities, Health and Human Services Secretary Michael O. Leavitt and CMS Acting Administrator Kerry Weems on November 7, 2007.
"We are very pleased that Judge Lamberth's ruling was not only fair, but positive for the community pharmacy industry," said NCPA CEO and Executive Vice President Bruce Roberts, R.Ph. and NACDS President and CEO Steven C. Anderson, IOM, CAE in a joint reaction to the preliminary injunction. "We cannot emphasize enough how these Medicaid cuts would hurt low-income patients who may have difficulty accessing their prescription medications in the nation's pharmacies.
"In a recent report, Stephen W. Schondelmeyer, Pharm.D., Ph.D., director of the PRIME Institute at the University of Minnesota, provided dire warnings about the effects of the cuts. Dr. Schondelmeyer indicated the retail pharmacy industry could see a loss of 10,000-12,000 pharmacies - a vast majority of which would be pharmacies in rural or inner city urban areas - over the next few years. As frontline health care providers, Americans rely on their retail pharmacies for medications and health information. The potential loss of a large number of pharmacies nationwide impacts not only Medicaid patients, but all patients who rely on their pharmacies for prescription and health care services.
He also indicated the dangers of publishing flawed data. "In general, transparency of price information is usually a good thing for consumers and for the market. However, when disclosed information is complex, confusing, or even inaccurate the transparency loses its value or even becomes counterproductive," he said.
The next step in the legal process is a final ruling by Judge Lamberth on the merits of the lawsuit. Until that time, the AMP rule put forth by CMS will not take effect.
NCPA and NACDS remain vigilant in pushing for a legislative solution. "Only new legislation can completely eliminate the severe damage to community pharmacies and ensure that patients continue to have access to their prescription medications," Roberts and Anderson said.
###
The National Association of Chain Drug Stores (NACDS) represents the nation's leading retail chain pharmacies and suppliers, helping them better meet the changing needs of their patients and customers. Chain pharmacies operate more than 38,000 pharmacies, employ 114,000 pharmacists, fill more than 2.4 billion prescriptions yearly, and have annual sales of nearly $700 billion. Other members include almost 1,000 suppliers of products and services to the chain drug industry. NACDS international membership has grown to include 104 members from 29 countries. For more information about NACDS, visit http://www.nacds.org/.
Special Thanks to Peter Wolfgram, RPh for this timely update.
FOR IMMEDIATE RELEASE
December 14, 2007
Contact: Chrissy Kopple, NACDS(703) 837-4266
John Norton, NCPA(703) 600-1174
Initial Victory for NACDS, NCPA in Lawsuit to Protect Low-Income Patients' Access to MedicationsJudge Grants Injunction Preventing CMS from Implementing Reimbursement Cuts, Posting Flawed AMP Data
Alexandria, VA - The National Association of Chain Drug Stores (NACDS) and the National Association of Community Pharmacists (NCPA) received an initial victory in their legal strategy to prevent Medicaid pharmacy reimbursement cuts. On the preliminary injunction motion filed by the groups on November 15, the United States District Court for the District of Columbia put the brakes on efforts by the Centers for Medicare and Medicaid Services (CMS) to impose Medicaid pharmacy reimbursement reductions scheduled to be implemented next month, and hamper access for low-income patients' to medications.
Judge Royce Lamberth ruled today that CMS will not be permitted to post data on the Internet related to the average manufacturer price (AMP) of generic pharmaceuticals. Nor will Medicaid reimbursement cuts take effect before Judge Lamberth has had an opportunity to fully review and make a final decision the merits of the lawsuit.
NACDS and NCPA filed a lawsuit against CMS and the U.S. Department of Health and Human Services, as well as, in their official capacities, Health and Human Services Secretary Michael O. Leavitt and CMS Acting Administrator Kerry Weems on November 7, 2007.
"We are very pleased that Judge Lamberth's ruling was not only fair, but positive for the community pharmacy industry," said NCPA CEO and Executive Vice President Bruce Roberts, R.Ph. and NACDS President and CEO Steven C. Anderson, IOM, CAE in a joint reaction to the preliminary injunction. "We cannot emphasize enough how these Medicaid cuts would hurt low-income patients who may have difficulty accessing their prescription medications in the nation's pharmacies.
"In a recent report, Stephen W. Schondelmeyer, Pharm.D., Ph.D., director of the PRIME Institute at the University of Minnesota, provided dire warnings about the effects of the cuts. Dr. Schondelmeyer indicated the retail pharmacy industry could see a loss of 10,000-12,000 pharmacies - a vast majority of which would be pharmacies in rural or inner city urban areas - over the next few years. As frontline health care providers, Americans rely on their retail pharmacies for medications and health information. The potential loss of a large number of pharmacies nationwide impacts not only Medicaid patients, but all patients who rely on their pharmacies for prescription and health care services.
He also indicated the dangers of publishing flawed data. "In general, transparency of price information is usually a good thing for consumers and for the market. However, when disclosed information is complex, confusing, or even inaccurate the transparency loses its value or even becomes counterproductive," he said.
The next step in the legal process is a final ruling by Judge Lamberth on the merits of the lawsuit. Until that time, the AMP rule put forth by CMS will not take effect.
NCPA and NACDS remain vigilant in pushing for a legislative solution. "Only new legislation can completely eliminate the severe damage to community pharmacies and ensure that patients continue to have access to their prescription medications," Roberts and Anderson said.
###
The National Association of Chain Drug Stores (NACDS) represents the nation's leading retail chain pharmacies and suppliers, helping them better meet the changing needs of their patients and customers. Chain pharmacies operate more than 38,000 pharmacies, employ 114,000 pharmacists, fill more than 2.4 billion prescriptions yearly, and have annual sales of nearly $700 billion. Other members include almost 1,000 suppliers of products and services to the chain drug industry. NACDS international membership has grown to include 104 members from 29 countries. For more information about NACDS, visit http://www.nacds.org/.
Special Thanks to Peter Wolfgram, RPh for this timely update.
Wednesday, December 12, 2007
Response from Congressman Denny Rehberg
Dear Eric :
Thank you for contacting me regarding protecting our community pharmacies, it's good to hear from you.
As you know, Montana 's independent and community pharmacies are facing a difficult business environment. Slow claims processing, low reimbursement rates, and an inability to negotiate prices on a level playing field with chain stores have put many of these small pharmacies out of business. That is why I have cosponsored two critical pieces of legislation, the Fair and Speedy Treatment (FAST) of Claims Act and the Community Pharmacy Fairness Act.
Independent pharmacies provide access to critical medications for many of Montana 's rural communities. However, due to a backlog in claims processing, many of these pharmacies aren't being reimbursed on time which can be devastating to business. This legislation would require these claims be processed quickly so independent pharmacies aren't being harmed.
The Fair and Speedy Treatment (FAST) of Claims Act of 2007 will ensure pharmacists are paid for their services in a timely manner by requiring Medicare Prescription Drug Plans to offer an electronic direct deposit for reimbursements to participating pharmacies. It also requires that claims submitted electronically must be paid within 14 days and all other claims be paid within 30 days.
The Community Pharmacy Fairness Act would grant independent pharmacies an exemption to anti-trust collusion regulations in regards to negotiating prices for their various medical supplies. Right now independent pharmacies are prohibited from sharing cost information or joint negotiations. However, larger chains such as CVS or Rite Aid do not face such restrictions. This bill would put the community pharmacies on the same level as the retail chains.
Both of these bills will benefit the more than 90 independent and community pharmacies in Montana . Rest assured that I will work tirelessly to provide timely economic relief to Montana 's small businesses.
Thanks again for contacting me. For further information or to sign up for my e-newsletter, please visit my website at www.house.gov/rehberg. Keep in touch.
Sincerely,
Denny Rehberg
Montana's Congressman
Thank you for contacting me regarding protecting our community pharmacies, it's good to hear from you.
As you know, Montana 's independent and community pharmacies are facing a difficult business environment. Slow claims processing, low reimbursement rates, and an inability to negotiate prices on a level playing field with chain stores have put many of these small pharmacies out of business. That is why I have cosponsored two critical pieces of legislation, the Fair and Speedy Treatment (FAST) of Claims Act and the Community Pharmacy Fairness Act.
Independent pharmacies provide access to critical medications for many of Montana 's rural communities. However, due to a backlog in claims processing, many of these pharmacies aren't being reimbursed on time which can be devastating to business. This legislation would require these claims be processed quickly so independent pharmacies aren't being harmed.
The Fair and Speedy Treatment (FAST) of Claims Act of 2007 will ensure pharmacists are paid for their services in a timely manner by requiring Medicare Prescription Drug Plans to offer an electronic direct deposit for reimbursements to participating pharmacies. It also requires that claims submitted electronically must be paid within 14 days and all other claims be paid within 30 days.
The Community Pharmacy Fairness Act would grant independent pharmacies an exemption to anti-trust collusion regulations in regards to negotiating prices for their various medical supplies. Right now independent pharmacies are prohibited from sharing cost information or joint negotiations. However, larger chains such as CVS or Rite Aid do not face such restrictions. This bill would put the community pharmacies on the same level as the retail chains.
Both of these bills will benefit the more than 90 independent and community pharmacies in Montana . Rest assured that I will work tirelessly to provide timely economic relief to Montana 's small businesses.
Thanks again for contacting me. For further information or to sign up for my e-newsletter, please visit my website at www.house.gov/rehberg. Keep in touch.
Sincerely,
Denny Rehberg
Montana's Congressman
Tuesday, December 11, 2007
Message from Peter Wolfgram, RPh: Update on DC Trip!
Fellow Pharmacists, Managers, and Owners
After a trip to Washington, DC in September and again in December to meet with Senator Baucus and staff, I have some important information to share with you.
September in DC was a hopeful time with the introduction of SB1951 in August and now being scored by the budget office. All bills introduced in congress must be scored as to how much this will cost the taxpayer. Those bills that have a cost associated with them must be offset by funds from some source in an attempt to keep the budget neutral. SB1951 corrected definitions in the Deficit Reduction Act as to what constituted a Retail Pharmacy and a Wholesaler. It also changed how AMP data is calculated and how the FUL is determined. It was taking an exceptionally long time to be scored and nobody knew why. The Prompt Pay bill is budget neutral so it does not have to be scored. Senator Baucus and staff were excited and very hopeful about this legislation. Representative Frank Pallone (NJ) introduced the same legislation in the house so pharmacy seemed to be in a fairly good position. Many senators and representatives signed on to these bills.
November was a time of uncertainty in DC. CMS made rumblings that they would begin publishing preliminary AMP data on a website beginning mid December. With this in mind and the lack of movement on any pharmacy legislation forced the NCPAS and NACDS to file a law suit in the DC courts to correct the inaccurate definitions and calculations of the DRA. After the lawsuit was filed, the above organizations also ask the court for an injunction to prevent the enactment of the AMP portion of the DRA saying that the enactment will cause irreparable harm to the pharmacy profession, retail pharmacies, and patient access.
December in DC is not all of good cheer. The good news is that the prompt pay bill will most likely be passed but will not really take effect until January of 2009. The PBMs whined and complained that it will take so much time to rewrite software and redo their computer systems. This I do not understand as we in Montana were paid every week by Medicaid with no extra time need to retool and no complaining on how much it will cost. Prompt pay will be coming to those of us still in business in 2009. AMP legislation is another story. Dead would be the correct term. While meeting with Senator Baucus and David Schwartz on December 5, the senator received an email memo addressed to the Senate Finance Committee from Mike Leavitt, head of HHS, stating that the Bush Administration wanted no changes to any part of Medicare Part D. Any changes would be met with the veto pen. Senator Baucus was visibly upset and let it be known to those of us present what he thought of the memo and the Bush Administration. He was not nice about it. Senator Grassley, the ranking Republican member had been making rumblings that nothing should be done about the DRA and AMP until we have more data on how this will affect pharmacy and patient access. This and the HHS memo have pretty much killed any AMP legislation this year. Senator Baucus and staff will be working on correcting the terms in DRA and asking for a 12 month delay in the implementation of the AMP and FUL changes. During this time the manufactures and wholesalers will submit data monthly and the AMP and FULs will be calculated but payments to pharmacies will not be tied to them. If this is successful then we have a 1 year reprieve. If not, then our last hope is the lawsuit and injunction. It is the administrations contention that pharmacists are overpaid and that there are way too many pharmacies in the country. With the enactment of the DRA, the marketplace will determine how many pharmacies will be left. Those pharmacies that are big enough and with the least amount of Medicaid will survive. The small independent pharmacies and small chains will be squeezed out of existence and the rural and inner city patient will suffer with lack of pharmaceutical services. The Bush Administration could care less.
The above information and views are personal observations do not necessarily represent the MPA, NCPA, nor the NACDS. Additional information can be obtained from Peter Wolfgram RPh, Belgrade, MT. Contact me at 406-388-0333 or Pwolfgram@bungalowdrug.com. I am available to meet in person with groups anywhere in Montana or northern Wyoming
Thanks for the update Peter!
After a trip to Washington, DC in September and again in December to meet with Senator Baucus and staff, I have some important information to share with you.
September in DC was a hopeful time with the introduction of SB1951 in August and now being scored by the budget office. All bills introduced in congress must be scored as to how much this will cost the taxpayer. Those bills that have a cost associated with them must be offset by funds from some source in an attempt to keep the budget neutral. SB1951 corrected definitions in the Deficit Reduction Act as to what constituted a Retail Pharmacy and a Wholesaler. It also changed how AMP data is calculated and how the FUL is determined. It was taking an exceptionally long time to be scored and nobody knew why. The Prompt Pay bill is budget neutral so it does not have to be scored. Senator Baucus and staff were excited and very hopeful about this legislation. Representative Frank Pallone (NJ) introduced the same legislation in the house so pharmacy seemed to be in a fairly good position. Many senators and representatives signed on to these bills.
November was a time of uncertainty in DC. CMS made rumblings that they would begin publishing preliminary AMP data on a website beginning mid December. With this in mind and the lack of movement on any pharmacy legislation forced the NCPAS and NACDS to file a law suit in the DC courts to correct the inaccurate definitions and calculations of the DRA. After the lawsuit was filed, the above organizations also ask the court for an injunction to prevent the enactment of the AMP portion of the DRA saying that the enactment will cause irreparable harm to the pharmacy profession, retail pharmacies, and patient access.
December in DC is not all of good cheer. The good news is that the prompt pay bill will most likely be passed but will not really take effect until January of 2009. The PBMs whined and complained that it will take so much time to rewrite software and redo their computer systems. This I do not understand as we in Montana were paid every week by Medicaid with no extra time need to retool and no complaining on how much it will cost. Prompt pay will be coming to those of us still in business in 2009. AMP legislation is another story. Dead would be the correct term. While meeting with Senator Baucus and David Schwartz on December 5, the senator received an email memo addressed to the Senate Finance Committee from Mike Leavitt, head of HHS, stating that the Bush Administration wanted no changes to any part of Medicare Part D. Any changes would be met with the veto pen. Senator Baucus was visibly upset and let it be known to those of us present what he thought of the memo and the Bush Administration. He was not nice about it. Senator Grassley, the ranking Republican member had been making rumblings that nothing should be done about the DRA and AMP until we have more data on how this will affect pharmacy and patient access. This and the HHS memo have pretty much killed any AMP legislation this year. Senator Baucus and staff will be working on correcting the terms in DRA and asking for a 12 month delay in the implementation of the AMP and FUL changes. During this time the manufactures and wholesalers will submit data monthly and the AMP and FULs will be calculated but payments to pharmacies will not be tied to them. If this is successful then we have a 1 year reprieve. If not, then our last hope is the lawsuit and injunction. It is the administrations contention that pharmacists are overpaid and that there are way too many pharmacies in the country. With the enactment of the DRA, the marketplace will determine how many pharmacies will be left. Those pharmacies that are big enough and with the least amount of Medicaid will survive. The small independent pharmacies and small chains will be squeezed out of existence and the rural and inner city patient will suffer with lack of pharmaceutical services. The Bush Administration could care less.
The above information and views are personal observations do not necessarily represent the MPA, NCPA, nor the NACDS. Additional information can be obtained from Peter Wolfgram RPh, Belgrade, MT. Contact me at 406-388-0333 or Pwolfgram@bungalowdrug.com. I am available to meet in person with groups anywhere in Montana or northern Wyoming
Thanks for the update Peter!
Tuesday, December 4, 2007
MPA Letter to Senator Baucus
November 29, 2007
Senator Max Baucus, Montana
507 Senate Hart Office Building
Washington, D.C. 20510
Dear Senator Baucus:
I am writing on behalf of the 500 plus members of the Montana Pharmacy Association to express our thanks and appreciation for your introduction of S. 1951 on August 2nd of this year. Passage of this bill is very important right now to community pharmacies in Montana and across the entire country. Our discussions with you in the summer of 2006 have borne great fruit. We thank you once again for the time and attention you gave us then and for your continued interest in this profession and its issues.
Since August we have been working with other state and national pharmacy organizations to obtain additional co-sponsors for the legislation. We were especially pleased to see Senator Tester co-sponsor them; and to see that Rep. Frank Pallone (NJ) has introduced a companion bill to S. 1951 in the House of Representatives which is HR3700. It is imperative to that S 1951 passes before the year end because the Deficit Reduction Act that defines Average Manufacture Price goes into effect on the first of the year. If this goes into effect, pharmacies will lose, on an average, 28% on any generic medication dispensed.
The healthcare debate continues and the key issues are still cost, quality and access. Our community pharmacists are the most accessible healthcare providers in the country. We still have pharmacies in Baker, Troy, Chinook and many other small and medium sized Montana communities. Thanks for working with us to be sure they are treated fairly so that they can stay in business and continue serving their patients and customers.
Thanks Again Senator Baucus,
James P. Seifert, President
P.O. Box 316
Troy Mt. 59935
(406) 295 4724
Senator Max Baucus, Montana
507 Senate Hart Office Building
Washington, D.C. 20510
Dear Senator Baucus:
I am writing on behalf of the 500 plus members of the Montana Pharmacy Association to express our thanks and appreciation for your introduction of S. 1951 on August 2nd of this year. Passage of this bill is very important right now to community pharmacies in Montana and across the entire country. Our discussions with you in the summer of 2006 have borne great fruit. We thank you once again for the time and attention you gave us then and for your continued interest in this profession and its issues.
Since August we have been working with other state and national pharmacy organizations to obtain additional co-sponsors for the legislation. We were especially pleased to see Senator Tester co-sponsor them; and to see that Rep. Frank Pallone (NJ) has introduced a companion bill to S. 1951 in the House of Representatives which is HR3700. It is imperative to that S 1951 passes before the year end because the Deficit Reduction Act that defines Average Manufacture Price goes into effect on the first of the year. If this goes into effect, pharmacies will lose, on an average, 28% on any generic medication dispensed.
The healthcare debate continues and the key issues are still cost, quality and access. Our community pharmacists are the most accessible healthcare providers in the country. We still have pharmacies in Baker, Troy, Chinook and many other small and medium sized Montana communities. Thanks for working with us to be sure they are treated fairly so that they can stay in business and continue serving their patients and customers.
Thanks Again Senator Baucus,
James P. Seifert, President
P.O. Box 316
Troy Mt. 59935
(406) 295 4724
MPA Letter to Congressman Rehberg
November 29, 2007
Rep. Denny Rehberg, Montana
U.S. House of RepresentativesRoom 516
Canon House Office Building
Washington, DC 20515
Dear Representative Rehberg:
I am writing on behalf of the 500 plus members of the Montana Pharmacy Association urge your support for the passage of HR 3700 introduced by Rep Frank Pallone (NJ). This is a companion bill of S. 1951 `Fair Medicaid Drug Payment Act of 2007 which was introduced by Senator Max Baucus and co-sponsored by Senator Jon Tester. Passage of this bill is very important right now to community pharmacies in Montana and across the entire country.
Our executive Director, Jim Smith, met with Brent Mead, in September, discussed HR 3700s with him and asked him to request your co-sponsorship of it. Jim tells me that Brent was very informed and knowledgeable about healthcare generally and rural healthcare issues in particular. Your commitment to Montana’s main street pharmacies came across loud and clear from Brent We thank you, for the time and attention you have given to this bill and your continued interest in this profession and its issues.
Since August we have been working with other state and national pharmacy organizations to obtain additional co-sponsors for the legislation. It is imperative to that HR 3700 passes before the year end because, the Deficit Reduction Act, that defines Average Manufacture Price, goes into effect on the first of the year. If this goes into effect, pharmacies will lose, on an average, 28% on any generic medication dispensed.
The healthcare debate continues and the key issues are still cost, quality and access. Our community pharmacists are the most accessible healthcare providers in the country. We still have pharmacies in Baker, Troy, Chinook and many other small and medium sized Montana communities. Thanks for working with us to be sure they are treated fairly so that they can stay in business and continue serving their patients and customers.
James P. Seifert, President
P.O. Box 316
Troy Mt. 59935
(406) 295 4724
Rep. Denny Rehberg, Montana
U.S. House of RepresentativesRoom 516
Canon House Office Building
Washington, DC 20515
Dear Representative Rehberg:
I am writing on behalf of the 500 plus members of the Montana Pharmacy Association urge your support for the passage of HR 3700 introduced by Rep Frank Pallone (NJ). This is a companion bill of S. 1951 `Fair Medicaid Drug Payment Act of 2007 which was introduced by Senator Max Baucus and co-sponsored by Senator Jon Tester. Passage of this bill is very important right now to community pharmacies in Montana and across the entire country.
Our executive Director, Jim Smith, met with Brent Mead, in September, discussed HR 3700s with him and asked him to request your co-sponsorship of it. Jim tells me that Brent was very informed and knowledgeable about healthcare generally and rural healthcare issues in particular. Your commitment to Montana’s main street pharmacies came across loud and clear from Brent We thank you, for the time and attention you have given to this bill and your continued interest in this profession and its issues.
Since August we have been working with other state and national pharmacy organizations to obtain additional co-sponsors for the legislation. It is imperative to that HR 3700 passes before the year end because, the Deficit Reduction Act, that defines Average Manufacture Price, goes into effect on the first of the year. If this goes into effect, pharmacies will lose, on an average, 28% on any generic medication dispensed.
The healthcare debate continues and the key issues are still cost, quality and access. Our community pharmacists are the most accessible healthcare providers in the country. We still have pharmacies in Baker, Troy, Chinook and many other small and medium sized Montana communities. Thanks for working with us to be sure they are treated fairly so that they can stay in business and continue serving their patients and customers.
James P. Seifert, President
P.O. Box 316
Troy Mt. 59935
(406) 295 4724
MPA Letter to Senator Tester
November 29, 2007
Senator Jon Tester, Montana
205 Senate Russell Office Building
Washington, D.C. 20510
Dear Senator Tester:
I am writing on behalf of the 500 plus members of the Montana Pharmacy Association to express our thanks and appreciation for your support and Co-sponsorship of S. 1951 `Fair Medicaid Drug Payment Act of 2007. Passage of this bill is very important right now to community pharmacies in Montana and across the entire country. Our discussions with you in the summer of 2006 have borne great fruit. We thank you once again for the time and attention you have given to this bill and your continued interest in this profession and its issues.
Since August we have been working with other state and national pharmacy organizations to obtain additional co-sponsors for the legislation. We were especially pleased to see that Rep. Frank Pallone (NJ) has introduced a companion bill to S. 1951 in the House of Representatives which is HR3700. It is imperative to that S 1951 passes before the year end because, the Deficit Reduction Act, that defines Average Manufacture Price, goes into effect on the first of the year. If this goes into effect, pharmacies will lose, on an average, 28% on any generic medication dispensed.
The healthcare debate continues and the key issues are still cost, quality and access. Our community pharmacists are the most accessible healthcare providers in the country. We still have pharmacies in Baker, Troy, Chinook and many other small and medium sized Montana communities. Thanks for working with us to be sure they are treated fairly so that they can stay in business and continue serving their patients and customers.
Thanks Again Senator Tester,
James P. Seifert, President
P.O. Box 316
Troy Mt. 59935
(406) 295 4724
Senator Jon Tester, Montana
205 Senate Russell Office Building
Washington, D.C. 20510
Dear Senator Tester:
I am writing on behalf of the 500 plus members of the Montana Pharmacy Association to express our thanks and appreciation for your support and Co-sponsorship of S. 1951 `Fair Medicaid Drug Payment Act of 2007. Passage of this bill is very important right now to community pharmacies in Montana and across the entire country. Our discussions with you in the summer of 2006 have borne great fruit. We thank you once again for the time and attention you have given to this bill and your continued interest in this profession and its issues.
Since August we have been working with other state and national pharmacy organizations to obtain additional co-sponsors for the legislation. We were especially pleased to see that Rep. Frank Pallone (NJ) has introduced a companion bill to S. 1951 in the House of Representatives which is HR3700. It is imperative to that S 1951 passes before the year end because, the Deficit Reduction Act, that defines Average Manufacture Price, goes into effect on the first of the year. If this goes into effect, pharmacies will lose, on an average, 28% on any generic medication dispensed.
The healthcare debate continues and the key issues are still cost, quality and access. Our community pharmacists are the most accessible healthcare providers in the country. We still have pharmacies in Baker, Troy, Chinook and many other small and medium sized Montana communities. Thanks for working with us to be sure they are treated fairly so that they can stay in business and continue serving their patients and customers.
Thanks Again Senator Tester,
James P. Seifert, President
P.O. Box 316
Troy Mt. 59935
(406) 295 4724
"Gone To The Hill"
Special thanks to Tobey Schule, RPh, Peter Wolfgram, RPh, and Gina McCarthy Pharm.D. for taking time from their busy schedules and family to go to the Hill to support Senator Baucus’s AMP (average manufacturer price) fix bill S.1951. NCPA (National Community Pharmacists Association) will be flying these 3 Montanans to DC this morning on Tuesday December 4th to talk to Senator Baucus, David Schwartz, and hopefully, a meeting with some of the Senate Finance Committee.
Centers for Medicare and Medicaid Services (CMS) had announced on July 6th, 2007 that Medicaid must use the new Federal Upper Limit (FUL), the maximum amount states can pay pharmacies for generic Medicaid drugs, which will be based on 250% of the lowest generic medications AMP. This rule is part of the Deficit Reduction Act of 2005, mandating CMS to reduce Federal and State Medicaid costs by 8.4 billion dollars over the next 5 years.
Ever since CMS had announced their drastic cuts for Medicaid reimbursement, pharmacy associations including: NCPA, NACDS, APhA, NRHA, and MPA are pushing for Senator Baucus’s S.1951 AMP fix. NCPA and NACDS have even joined forces and filed suit against CMS for their AMP ruling. This is all for a good reason. The Government Accountability Office (GAO) identified the reimbursement on average is 36% less than the acquisition costs for generic medications. What this means is pharmacies may have to turn Medicaid patients away or close their doors trying to serve them. Tobey, Peter, and Gina are in DC to meet with NCPA then head to the Hill to speak with Senator Baucus, his staff, and maybe some members of the Senate Finance Committee in attempts to safeguard patient access to community pharmacies by giving their support for S.1951 and H.R.3700.
Senator Baucus had introduced S.1951 "The Fair Medicaid Drug Payment Act of 2007" on August 2nd, 2007. For the most part, this bill removes the outlying mail order acquisition costs from the mix on figuring AMP, uses Average AMP instead of Lowest AMP, and raises reimbursement from 250% to 300%. Please visit GrizRPh.com “In the Spotlight” for more information.
In addition, Representative Pallone had introduced H.R.3700 on October 28th, which is the companion bill to Senator Baucus's S.1951, also known as the "The Fair Medicaid Drug Payment Act of 2007" in the Senate. The two bills can be meshed easily and can save our pharmacies before the dreaded new AMP attacks pharmacies pocket books.
Jim Smith, Executive Director of the Montana Pharmacy Association explains, ‘this is where I figured we'd be around now with AMP legislation...S.1951 is the last realistic vehicle for getting anything done on AMP this session of Congress. That's why I felt strongly that I needed to go to DC in September...to beat the drum with my counterparts in other states, and with APhA (American Pharmacists Association) regarding AMP and S.1951. Both S.1951 and H.R.3700 are identical versions of AMP legislation in the Senate and the House and we have two committee chairs, both Senator Baucus, Chairman of the U.S. Finance Committee, and Representative Pallone, Chair of the Subcommittee on Health in the Energy and Commerce Committee, which has sole jurisdiction over Medicaid, sponsoring these bills which is key to our success in the next week or so.’
In addition, Jim Seifert, RPh, President of the Montana Pharmacy Association, asked Tobey Schule to hand deliver letters of support from MPA, in which you can read on GrizRPh News just above..Lets give a special thanks to Tobey, Peter, and Gina for their efforts in safeguarding patient access to community pharmacies. Hats off to all three of you…Thank you!
Eric Shields, Pharm.D.
Centers for Medicare and Medicaid Services (CMS) had announced on July 6th, 2007 that Medicaid must use the new Federal Upper Limit (FUL), the maximum amount states can pay pharmacies for generic Medicaid drugs, which will be based on 250% of the lowest generic medications AMP. This rule is part of the Deficit Reduction Act of 2005, mandating CMS to reduce Federal and State Medicaid costs by 8.4 billion dollars over the next 5 years.
Ever since CMS had announced their drastic cuts for Medicaid reimbursement, pharmacy associations including: NCPA, NACDS, APhA, NRHA, and MPA are pushing for Senator Baucus’s S.1951 AMP fix. NCPA and NACDS have even joined forces and filed suit against CMS for their AMP ruling. This is all for a good reason. The Government Accountability Office (GAO) identified the reimbursement on average is 36% less than the acquisition costs for generic medications. What this means is pharmacies may have to turn Medicaid patients away or close their doors trying to serve them. Tobey, Peter, and Gina are in DC to meet with NCPA then head to the Hill to speak with Senator Baucus, his staff, and maybe some members of the Senate Finance Committee in attempts to safeguard patient access to community pharmacies by giving their support for S.1951 and H.R.3700.
Senator Baucus had introduced S.1951 "The Fair Medicaid Drug Payment Act of 2007" on August 2nd, 2007. For the most part, this bill removes the outlying mail order acquisition costs from the mix on figuring AMP, uses Average AMP instead of Lowest AMP, and raises reimbursement from 250% to 300%. Please visit GrizRPh.com “In the Spotlight” for more information.
In addition, Representative Pallone had introduced H.R.3700 on October 28th, which is the companion bill to Senator Baucus's S.1951, also known as the "The Fair Medicaid Drug Payment Act of 2007" in the Senate. The two bills can be meshed easily and can save our pharmacies before the dreaded new AMP attacks pharmacies pocket books.
Jim Smith, Executive Director of the Montana Pharmacy Association explains, ‘this is where I figured we'd be around now with AMP legislation...S.1951 is the last realistic vehicle for getting anything done on AMP this session of Congress. That's why I felt strongly that I needed to go to DC in September...to beat the drum with my counterparts in other states, and with APhA (American Pharmacists Association) regarding AMP and S.1951. Both S.1951 and H.R.3700 are identical versions of AMP legislation in the Senate and the House and we have two committee chairs, both Senator Baucus, Chairman of the U.S. Finance Committee, and Representative Pallone, Chair of the Subcommittee on Health in the Energy and Commerce Committee, which has sole jurisdiction over Medicaid, sponsoring these bills which is key to our success in the next week or so.’
In addition, Jim Seifert, RPh, President of the Montana Pharmacy Association, asked Tobey Schule to hand deliver letters of support from MPA, in which you can read on GrizRPh News just above..Lets give a special thanks to Tobey, Peter, and Gina for their efforts in safeguarding patient access to community pharmacies. Hats off to all three of you…Thank you!
Eric Shields, Pharm.D.
Wednesday, November 21, 2007
Medicaid's Dispensing Fee And Compounding Regulations
On November 14th the Montana Pharmacy Association (MPA) was at the ARM Hearing in Helena to explain to Montana Medicaid the importance of special packaging and current compounding regulations.
The ARM amendment 37.86.1101 and 37.86.1105 pertains to Medicaid reimbursement for dispensing fees and outpatient, compound prescriptions. The pharmacy dispensing fee is based on the pharmacy’s average cost of filling prescriptions and whether the pharmacy dispenses a generic, preferred drug list or non-preferred drug. The average cost of filling a prescription will be based on the direct and indirect costs that can be allocated to the cost of the prescription department and that of filling a prescription, as determined from the Montana Dispensing Fee Questionnaire. The average statewide dispensing fee is estimated to be $8.75 for preferred drug list medications. You may call Montana Medicaid to see where your pharmacy dispensing fee falls between $6.16 to a maximum of $10 for brand and generic preferred drug list medications. A dispensing fee of $5.50 will be given for all non-preferred drug list medications.
Unfortunately, the unit dosing fee of $0.75 per prescription will no longer be in effect after January 1st, 2008 when all this kicks in. CMS had tied the cost of unit dosing (special packaging), overhead costs, prescription volume, and personnel wages all into the dispensing fee. Since CMS will not allow for additional unit dosing fees, MPA suggested to give an additional 1$ dispensing fee for each medication to pharmacies who special package medications due to the additional costs of materials, extra “man” hours, delivering of the packages, etc.
In addition, any new store would only be assigned a 6 month interim dispensing fee of $5.50. MPA suggested that the new store be assigned the average fee of $8.75 since the new stores have not built up volumes and costs would be high.
Montana Medicaid’s proposed rule on compounding consists of using line item billing only (no more 00888 codes), and the use of compounding dispensing fees based on level of effort: $12.50, $17.50, $22.50. Any prescription over the level of effort of $12.50 dispensing fee would require a call the to the Prior Authorization unit to receive one of the higher dispensing fees. Another issue is that Medicaid had stated in the hearing notice that “the department encourages providers to explore rebatable or less costly excipients,” this would require extra inventory of rebate able products, and from what was explained by compounding pharmacists, PCCA has no or very few rebate able products and requires their new pharmacies to use their products, exclusively. In addition, reimbursement for mainly the rebate able ingredient still does not account for all the overhead costs associated with compounding. All three compounding pharmacists who spoke, said at these reimbursement rates, they would not be able to serve the Medicaid population. MPA’s position is to have no change in the current compounding program and to continue to use usual and customary fee, especially since compounding prescriptions is less than 1% of the Medicaid budget. Please visit GrizRPh.com or RxMT.org for further information.
The ARM amendment 37.86.1101 and 37.86.1105 pertains to Medicaid reimbursement for dispensing fees and outpatient, compound prescriptions. The pharmacy dispensing fee is based on the pharmacy’s average cost of filling prescriptions and whether the pharmacy dispenses a generic, preferred drug list or non-preferred drug. The average cost of filling a prescription will be based on the direct and indirect costs that can be allocated to the cost of the prescription department and that of filling a prescription, as determined from the Montana Dispensing Fee Questionnaire. The average statewide dispensing fee is estimated to be $8.75 for preferred drug list medications. You may call Montana Medicaid to see where your pharmacy dispensing fee falls between $6.16 to a maximum of $10 for brand and generic preferred drug list medications. A dispensing fee of $5.50 will be given for all non-preferred drug list medications.
Unfortunately, the unit dosing fee of $0.75 per prescription will no longer be in effect after January 1st, 2008 when all this kicks in. CMS had tied the cost of unit dosing (special packaging), overhead costs, prescription volume, and personnel wages all into the dispensing fee. Since CMS will not allow for additional unit dosing fees, MPA suggested to give an additional 1$ dispensing fee for each medication to pharmacies who special package medications due to the additional costs of materials, extra “man” hours, delivering of the packages, etc.
In addition, any new store would only be assigned a 6 month interim dispensing fee of $5.50. MPA suggested that the new store be assigned the average fee of $8.75 since the new stores have not built up volumes and costs would be high.
Montana Medicaid’s proposed rule on compounding consists of using line item billing only (no more 00888 codes), and the use of compounding dispensing fees based on level of effort: $12.50, $17.50, $22.50. Any prescription over the level of effort of $12.50 dispensing fee would require a call the to the Prior Authorization unit to receive one of the higher dispensing fees. Another issue is that Medicaid had stated in the hearing notice that “the department encourages providers to explore rebatable or less costly excipients,” this would require extra inventory of rebate able products, and from what was explained by compounding pharmacists, PCCA has no or very few rebate able products and requires their new pharmacies to use their products, exclusively. In addition, reimbursement for mainly the rebate able ingredient still does not account for all the overhead costs associated with compounding. All three compounding pharmacists who spoke, said at these reimbursement rates, they would not be able to serve the Medicaid population. MPA’s position is to have no change in the current compounding program and to continue to use usual and customary fee, especially since compounding prescriptions is less than 1% of the Medicaid budget. Please visit GrizRPh.com or RxMT.org for further information.
Sunday, November 11, 2007
H.R. 971 and S.2161...Hand in Hand through Anti-trust Law.
S.2161 was introduced into the Senate by Senator Johnny Isakson [GA] (introduced 10/15/2007). Bill Text here. This is a companion bill to H.R. 971. These are bills to ensure and foster continued patient safety and quality of care by making the antitrust laws apply to negotiations between groups of independent pharmacies and health plans and health insurance issuers (including health plans under parts C and D of the Medicare Program) in the same manner as such laws apply to protected activities under the National Labor Relations Act.
In addition, The House Judiciary Committee passed HR 971 by a unanimous voice vote on Wednesday, Nov. 7. Read ACPCN ALERT here.
Also, H.R. 1474 "Fair and Speedy Treatment (FAST) of Medicare Prescription Drug Claims Act of 2007" Update: has a whopping 229 co-sponsors and is being referred to the Subcommittee on Health.
In addition, The House Judiciary Committee passed HR 971 by a unanimous voice vote on Wednesday, Nov. 7. Read ACPCN ALERT here.
Also, H.R. 1474 "Fair and Speedy Treatment (FAST) of Medicare Prescription Drug Claims Act of 2007" Update: has a whopping 229 co-sponsors and is being referred to the Subcommittee on Health.
Sunday, October 28, 2007
IMPORTANT NOTICE: Medicaid Reimbursement!!!
Representative Pallone has introduced a very important piece of legislation into the House of Representatives…H.R.3700.
H.R.3700, the `Fair Medicaid Drug Payment Act of 2007', is the bill we NEED to SAVE OUR HIDES before the implementation of the new AMP. H.R.3700 can be meshed easily with Baucus’s S.1951, also known as the `Fair Medicaid Drug Payment Act of 2007' in the Senate, and will keep our heads above water until we can tweak it later, and maybe implement some of H.R.3140 into it when time permits. Both S.1951 and H.R.3700 are easily implemented into Congress since they both deal with a 300 percent of the weighted average of the most recent average manufacturer prices for purchase by retail community pharmacies and we don’t need to bring out the calculator again and spend a bunch of time on calculations as we would with H.R.3140’s Retail Acquisition Costs.
So please…at this point in time support H.R.3700 and S.1951, the `Fair Medicaid Drug Payment Act of 2007' and please write to Congressman Rehberg thanking him for his previous support of pharmacy Medicare legislation H.R.971 and H.R.1474 and to PLEASE CO-SPONSOR H.R.3700.
S.1951 and H.R.3700 are our only hope at this point in time before Congress packs up and goes home to Save our Community Pharmacy Hides before the implementation of the devastating CMS proposed AMP, which is 36% below our acquisition cost according to the GAO studies. With this in mind, please don’t delay, call Congressman Rehberg at (406) 256-1019 or email him at http://www.house.gov/writerep/ or go to www.grizrph.com and click on REPRESENTATIVE CONTACTS for other numbers/ fax numbers/ emails, etc. Time is of the essence. For more information on this bill, CMS, AMP, GAO and other Medicaid/ Medicare bills, please visit Grizrph.com…In the Spotlight!
"Representative Pallone and Senator Baucus are in strong positions to move their respective legislation, get into a conference, and send a single bill to the President before they adjourn" states Executive Director of MPA Jim Smith.
In addition H.R.1474 (Medicare Prompt Payment Legislation) has House Majority of 223 of 435 members signed on as co-sponsors.
And please visit GrizRph.com, In the Spotlight, for the low-down on H.R.971 (Medicare Pharmacy Negotiation Bill)…it has gone to hearing and independent pharmacies got maximum results.
Please visit the Montana Pharmacy Association (MPA) website (www.rxmt.org) for important updates including letters to our Representative and Senators by MPA President Jim Seifert, a great article by Carla Cobb entitled “Pharmacists Aren’t Just Bottle Fillers”, Dean Forbes Newsletter, Update on Rosiglitazone concerns by Sherill Brown, and much more.
Thank you,
Eric Shields, Pharm.D.
H.R.3700, the `Fair Medicaid Drug Payment Act of 2007', is the bill we NEED to SAVE OUR HIDES before the implementation of the new AMP. H.R.3700 can be meshed easily with Baucus’s S.1951, also known as the `Fair Medicaid Drug Payment Act of 2007' in the Senate, and will keep our heads above water until we can tweak it later, and maybe implement some of H.R.3140 into it when time permits. Both S.1951 and H.R.3700 are easily implemented into Congress since they both deal with a 300 percent of the weighted average of the most recent average manufacturer prices for purchase by retail community pharmacies and we don’t need to bring out the calculator again and spend a bunch of time on calculations as we would with H.R.3140’s Retail Acquisition Costs.
So please…at this point in time support H.R.3700 and S.1951, the `Fair Medicaid Drug Payment Act of 2007' and please write to Congressman Rehberg thanking him for his previous support of pharmacy Medicare legislation H.R.971 and H.R.1474 and to PLEASE CO-SPONSOR H.R.3700.
S.1951 and H.R.3700 are our only hope at this point in time before Congress packs up and goes home to Save our Community Pharmacy Hides before the implementation of the devastating CMS proposed AMP, which is 36% below our acquisition cost according to the GAO studies. With this in mind, please don’t delay, call Congressman Rehberg at (406) 256-1019 or email him at http://www.house.gov/writerep/ or go to www.grizrph.com and click on REPRESENTATIVE CONTACTS for other numbers/ fax numbers/ emails, etc. Time is of the essence. For more information on this bill, CMS, AMP, GAO and other Medicaid/ Medicare bills, please visit Grizrph.com…In the Spotlight!
"Representative Pallone and Senator Baucus are in strong positions to move their respective legislation, get into a conference, and send a single bill to the President before they adjourn" states Executive Director of MPA Jim Smith.
In addition H.R.1474 (Medicare Prompt Payment Legislation) has House Majority of 223 of 435 members signed on as co-sponsors.
And please visit GrizRph.com, In the Spotlight, for the low-down on H.R.971 (Medicare Pharmacy Negotiation Bill)…it has gone to hearing and independent pharmacies got maximum results.
Please visit the Montana Pharmacy Association (MPA) website (www.rxmt.org) for important updates including letters to our Representative and Senators by MPA President Jim Seifert, a great article by Carla Cobb entitled “Pharmacists Aren’t Just Bottle Fillers”, Dean Forbes Newsletter, Update on Rosiglitazone concerns by Sherill Brown, and much more.
Thank you,
Eric Shields, Pharm.D.
Sunday, September 30, 2007
Recap on Current Legislation
Things are looking up in Montana. We are very fortunate to have such supporting representatives on pharmacy issues. Please thank Senator Tester for co-sponsoring S1951 and S1954. As of Monday Sept 24, 2007, Senator Tester co-sponsored Senatot Baucus’s pharmacy legislation S1954 ”Pharmacy Access improvement Act (PhAIM) of 2007” and S1951 “The Fair Medicaid Drug Payment Act”. You may view this legislation on GrizRph.com, In The Spotlight.
In addition, please call or e-mail Congressman Rehberg, to ask him to co-sponsor HR3140 “The Saving Our Community Pharmacies Act of 2007”. This is the final remaining piece of the pharmacy legislation puzzle. We can’t quit now with so much that we’ve gained. Rehberg’s office has already heard from all the usual pharmacists and individuals concerned about pharmacy legislation and are waiting to hear from more of those pharmacists and individuals deep in the trenches.
Let Congressman Rehberg know how devastating it would be to your pharmacy to be reimbursed on average 36% below acquisition cost for the medications you have spent time and money on filling, not to mention special packaging. Then please take it one step further and explain how this will affect your patients, whom you take so well care of, by either having to reject Medicaid patients or having to close your doors due to low reimbursement. Please, it just takes a few minutes…Contact Congressman Rehberg.
Read all about HR3140 at GrizRPh.com, In the Spotlight. In addition, please thank Congressman Rehberg for all his previous support of pharmacy by co-sponsoring all the other important pharmacy legislation in the House... such as HR1474 and HR971.
These are all very crucial pieces of pharmacy legislation and we should be very thankful to have such supporting representatives. If you haven’t done so, please call or e-mail their offices to thank them at www.grizrph.com/repcontact.htm.
LIST OF CURRENT FEDERAL PHARMACY LEGISLATION
As of 9/30/07
Sincerely,
Eric Shields, Pharm D
In addition, please call or e-mail Congressman Rehberg, to ask him to co-sponsor HR3140 “The Saving Our Community Pharmacies Act of 2007”. This is the final remaining piece of the pharmacy legislation puzzle. We can’t quit now with so much that we’ve gained. Rehberg’s office has already heard from all the usual pharmacists and individuals concerned about pharmacy legislation and are waiting to hear from more of those pharmacists and individuals deep in the trenches.
Let Congressman Rehberg know how devastating it would be to your pharmacy to be reimbursed on average 36% below acquisition cost for the medications you have spent time and money on filling, not to mention special packaging. Then please take it one step further and explain how this will affect your patients, whom you take so well care of, by either having to reject Medicaid patients or having to close your doors due to low reimbursement. Please, it just takes a few minutes…Contact Congressman Rehberg.
Read all about HR3140 at GrizRPh.com, In the Spotlight. In addition, please thank Congressman Rehberg for all his previous support of pharmacy by co-sponsoring all the other important pharmacy legislation in the House... such as HR1474 and HR971.
These are all very crucial pieces of pharmacy legislation and we should be very thankful to have such supporting representatives. If you haven’t done so, please call or e-mail their offices to thank them at www.grizrph.com/repcontact.htm.
LIST OF CURRENT FEDERAL PHARMACY LEGISLATION
As of 9/30/07
Sincerely,
Eric Shields, Pharm D
Thursday, August 16, 2007
Summaries for S.1951 and S.1954
Please visit In the Spotlight to read very clear and concise summaries on these two very vital bills, as well as other vital bills regarding CMS and AMP!
Special thanks to APhA, Thomas R. Clark, RPh, MHS Director of Policy & AdvocacyAmerican Society of Consultant Pharmacists, and Jim Smith, Executive Director of Montana Pharmacy Association for breaking these bills down and/or sharing them with us!
Special thanks to APhA, Thomas R. Clark, RPh, MHS Director of Policy & AdvocacyAmerican Society of Consultant Pharmacists, and Jim Smith, Executive Director of Montana Pharmacy Association for breaking these bills down and/or sharing them with us!
Sunday, August 12, 2007
Act Now..S.1954; S.1951 and H.R.1474 and H.R.1340
Finally…Hope, but a lot of work must be done before our goals of protecting pharmacy and preserving patient access to community pharmacies is accomplished.
Community pharmacies fill the void in health care by offering special services and medication packaging to further our health care system. Without our services and extra time providing theses services, many patients would be noncompliant and/or uneducated about the medication they or their loved one take; not to mention all pharmacists are the “first line against pharmaceutical and prescribing errors”. The list of services community pharmacies provide is numerous and is vital to our community, but unfortunately these services are being overlooked by our government wrapping all pharmacies into the same category with the mind set that all pharmacies, including PBM mail order pharmacies, have the same costs, services, and reimbursements. As we know this is clearly NOT TRUE!
Thanks to our very own Senator Baucus and Iowa’s Senator Grassley, they are putting their best foot forward by introducing the Pharmacy Access improvement Act (PhAIM) of 2007 (S.1954). This bill provides common sense fixes to the Medicare PartD program including 14 day electronic fund transfer for prompt reimbursement and paper claims within 30 days. Currently pharmacies are lucky to get paid by PBM’s in 30 to 60 days with the average pharmacy having to borrow $70,000 to hundreds of thousands of dollars just to make ends meet. In addition, PBM’s get paid monthly IN ADVANCE by Medicare, yet PBM’s “enjoy a considerable interest-earning float on tax-payers dollars intended to reimburse community pharmacies for serving their patients” said Roberts, RPh, of NCPA. During the year 2006, 1,152 community pharmacies were ‘shuttered or sold’ according to the NCPA-Pfizer Digest. The only thing new introduced into the pharmacy system was Medicare Part D, otherwise, community pharmacies would have continued their steady growth rate.
Similarly, H.R.1474 labeled the “Fair and Speed Treatment of Medicare Prescription Drug Claims” is making headway with a total of 190 bipartisan supporters. Please ask Congressman Rehberg to support H.R.1474 (GrizRPh News April 13th) as well as H.R.3140 (GrizRph News July 26th). Both these bills are similar to bills in the Senate, but we truly need to give every thing we’ve got to make this work since CMS has already made there statements to NOT CHANGE reimbursement which will be devastating to our pharmacies if these or similar bills do not pass. Rehberg’s staff is aware of these bills but they need to here from us…the pharmacists, technicians, and pharmacy owners in the trenches who see the devastating affects of Medicare and soon to be Medicaid on a daily basis with low and slow reimbursement. It just takes a few minutes to pick up the phone or email...yes, your opinion matters greatly!!! In numbers, we can stop these devastating affects to pharmacy!
In addition, Senator Baucus also introduced AMP fix legislation “The Fair Medicaid Drug Payment Act” (S.1951) which may save all our hides if implemented!!! Without this bill and other current pharmacy legislation, community pharmacies will be paid by Medicaid, on average, 36% below acquisition cost for medications, which will lead community pharmacies to eventually not participate by turning their backs on Medicaid patients, or close their doors. The Deficit Reduction Act of 2005 is suppose to decrease healthcare costs and national deficit not increase deficit and decrease patient healthcare, compliance, and pharmacy availability! Senator Baucus’s AMP fix focuses on a “300% reimbursement of AMP by COMMUNITY PHARMACIES on a nationwide basis and that FUL (Federal Upper Limits) do not vary monthly upon rebates, discounts or other pricing practices as well as the removal of mail order transactions from its calculations. Please support your pharmacy, and paycheck, by (1) thanking Senator Baucus for both S.1954 and S.1951. (2) Please also ask Senator Testor to Co-Sponsor S.1954 and other Senate pharmacy bills and (3) Please ask Congessman Rehberg to Co-Sponsor H.R.1474 (GrizRPh News April 13th) and H.R.3140 (GrizRPhNews July 26th). Please do your part and phone or email…we can protect pharmacy by standing up and shouting in one voice OR sit back and watch the devastating affects take place! Your choice will matter!!! Thank you for supporting Community Pharmacies as well as ALL PHARMACIES nationwide by writing to your Representatives! Please visit http://www.rxmt.org/ for a concise summary of these bills!
Thank you,
Eric Shields, PharmD
GrizRPh.com
Community pharmacies fill the void in health care by offering special services and medication packaging to further our health care system. Without our services and extra time providing theses services, many patients would be noncompliant and/or uneducated about the medication they or their loved one take; not to mention all pharmacists are the “first line against pharmaceutical and prescribing errors”. The list of services community pharmacies provide is numerous and is vital to our community, but unfortunately these services are being overlooked by our government wrapping all pharmacies into the same category with the mind set that all pharmacies, including PBM mail order pharmacies, have the same costs, services, and reimbursements. As we know this is clearly NOT TRUE!
Thanks to our very own Senator Baucus and Iowa’s Senator Grassley, they are putting their best foot forward by introducing the Pharmacy Access improvement Act (PhAIM) of 2007 (S.1954). This bill provides common sense fixes to the Medicare PartD program including 14 day electronic fund transfer for prompt reimbursement and paper claims within 30 days. Currently pharmacies are lucky to get paid by PBM’s in 30 to 60 days with the average pharmacy having to borrow $70,000 to hundreds of thousands of dollars just to make ends meet. In addition, PBM’s get paid monthly IN ADVANCE by Medicare, yet PBM’s “enjoy a considerable interest-earning float on tax-payers dollars intended to reimburse community pharmacies for serving their patients” said Roberts, RPh, of NCPA. During the year 2006, 1,152 community pharmacies were ‘shuttered or sold’ according to the NCPA-Pfizer Digest. The only thing new introduced into the pharmacy system was Medicare Part D, otherwise, community pharmacies would have continued their steady growth rate.
Similarly, H.R.1474 labeled the “Fair and Speed Treatment of Medicare Prescription Drug Claims” is making headway with a total of 190 bipartisan supporters. Please ask Congressman Rehberg to support H.R.1474 (GrizRPh News April 13th) as well as H.R.3140 (GrizRph News July 26th). Both these bills are similar to bills in the Senate, but we truly need to give every thing we’ve got to make this work since CMS has already made there statements to NOT CHANGE reimbursement which will be devastating to our pharmacies if these or similar bills do not pass. Rehberg’s staff is aware of these bills but they need to here from us…the pharmacists, technicians, and pharmacy owners in the trenches who see the devastating affects of Medicare and soon to be Medicaid on a daily basis with low and slow reimbursement. It just takes a few minutes to pick up the phone or email...yes, your opinion matters greatly!!! In numbers, we can stop these devastating affects to pharmacy!
In addition, Senator Baucus also introduced AMP fix legislation “The Fair Medicaid Drug Payment Act” (S.1951) which may save all our hides if implemented!!! Without this bill and other current pharmacy legislation, community pharmacies will be paid by Medicaid, on average, 36% below acquisition cost for medications, which will lead community pharmacies to eventually not participate by turning their backs on Medicaid patients, or close their doors. The Deficit Reduction Act of 2005 is suppose to decrease healthcare costs and national deficit not increase deficit and decrease patient healthcare, compliance, and pharmacy availability! Senator Baucus’s AMP fix focuses on a “300% reimbursement of AMP by COMMUNITY PHARMACIES on a nationwide basis and that FUL (Federal Upper Limits) do not vary monthly upon rebates, discounts or other pricing practices as well as the removal of mail order transactions from its calculations. Please support your pharmacy, and paycheck, by (1) thanking Senator Baucus for both S.1954 and S.1951. (2) Please also ask Senator Testor to Co-Sponsor S.1954 and other Senate pharmacy bills and (3) Please ask Congessman Rehberg to Co-Sponsor H.R.1474 (GrizRPh News April 13th) and H.R.3140 (GrizRPhNews July 26th). Please do your part and phone or email…we can protect pharmacy by standing up and shouting in one voice OR sit back and watch the devastating affects take place! Your choice will matter!!! Thank you for supporting Community Pharmacies as well as ALL PHARMACIES nationwide by writing to your Representatives! Please visit http://www.rxmt.org/ for a concise summary of these bills!
Thank you,
Eric Shields, PharmD
GrizRPh.com
Thursday, July 26, 2007
"A New Hope"
Please contact Congressman Rehberg and urge him to co-sponsor H.R. 3140.
In response to the Centers for Medicaid and Medicare Services (CMS) final ruling on Average Manufacturer Price (AMP), REPS. BOYDA, EMERSON AND 30 HOUSE MEMBERS INTRODUCE COMMON-SENSE FIXES TO MEDICAID PHARMACY REIMBURSEMENT RULE FOR GENERIC PRESCRIPTION DRUGS. See CMS final ruling posted on GrizRPh on July 11th, 2007.
H.R. 3140 “The Saving Our Community Pharmacies Act of 2007” rectifies the current pricing discrepancies and maintains patient- pharmacist relationship by:
• Redefining the pharmacy reimbursement benchmark to accurately reflect pharmacy acquisition costs. Retail Acquisition Cost (RAC) is the median price for each drug based on a quarterly survey of actual invoices subject to audit from a 5% representative sample of pharmacies nationwide. A FUL based on RAC will allow states to pay pharmacies accurately and preserve patient access.
• Excluding all sales to mail order facilities, as well as any pharmacy benefit manager (PBM) rebates and price concessions that are not available to retail pharmacies.
• Properly defining the retail class of trade to only include retail community pharmacies.
• Including provisions to drive generic utilization which would increase taxpayer and government savings.
Read the H.R. 3140 Fact Sheet provided by NCPA.
“The situation is serious, extremely serious,” said Bruce Roberts, RPh, NCPA executive vice president and CEO. “But it is not hopeless. It is not hopeless if we all take action in a well-planned, sustained effort. We’ve got about six months before the pain begins. Let’s use every day.”
Please visit the NCPA Website for more information on H.R. 3140.
Please contact Congressman Rehberg and urge him to co-sponsor H.R. 3140 through the GrizRPh.com Representative Contacts page. If we act now we may be able to prevent the Medicaid AMP Tragedy and save jobs and independent stores nationwide. Please do your part…this may be our last chance!
Thanks to NCPA and MPA for awareness on this issue!
Eric Shields, Pharm.D.
GrizRPh.com
In response to the Centers for Medicaid and Medicare Services (CMS) final ruling on Average Manufacturer Price (AMP), REPS. BOYDA, EMERSON AND 30 HOUSE MEMBERS INTRODUCE COMMON-SENSE FIXES TO MEDICAID PHARMACY REIMBURSEMENT RULE FOR GENERIC PRESCRIPTION DRUGS. See CMS final ruling posted on GrizRPh on July 11th, 2007.
H.R. 3140 “The Saving Our Community Pharmacies Act of 2007” rectifies the current pricing discrepancies and maintains patient- pharmacist relationship by:
• Redefining the pharmacy reimbursement benchmark to accurately reflect pharmacy acquisition costs. Retail Acquisition Cost (RAC) is the median price for each drug based on a quarterly survey of actual invoices subject to audit from a 5% representative sample of pharmacies nationwide. A FUL based on RAC will allow states to pay pharmacies accurately and preserve patient access.
• Excluding all sales to mail order facilities, as well as any pharmacy benefit manager (PBM) rebates and price concessions that are not available to retail pharmacies.
• Properly defining the retail class of trade to only include retail community pharmacies.
• Including provisions to drive generic utilization which would increase taxpayer and government savings.
Read the H.R. 3140 Fact Sheet provided by NCPA.
“The situation is serious, extremely serious,” said Bruce Roberts, RPh, NCPA executive vice president and CEO. “But it is not hopeless. It is not hopeless if we all take action in a well-planned, sustained effort. We’ve got about six months before the pain begins. Let’s use every day.”
Please visit the NCPA Website for more information on H.R. 3140.
Please contact Congressman Rehberg and urge him to co-sponsor H.R. 3140 through the GrizRPh.com Representative Contacts page. If we act now we may be able to prevent the Medicaid AMP Tragedy and save jobs and independent stores nationwide. Please do your part…this may be our last chance!
Thanks to NCPA and MPA for awareness on this issue!
Eric Shields, Pharm.D.
GrizRPh.com
Wednesday, July 11, 2007
AMP Final Ruling Disasterous for Community Pharmacies
Medicaid Cuts Are Final and Devastating
The Centers for Medicare & Medicaid Services (CMS) have set their rules on July 6th 2007 and made them public on July 9th 2007 for viewing. Unfortunately, this rule still doesn’t provide a clear definition of Average Manufacturers Price (AMP), which is used in Medicaid’s reimbursement to pharmacies. Despite numerous attempts from pharmacists, and pharmacy organizations, Medicaid must use the new Federal Upper Limit (FUL), the maximum amount states can pay pharmacies for generic Medicaid drugs, that will be based on 250% of the lowest generic medications AMP.
This rule is part of the Deficit Reduction Act of 2005, mandating CMS to reduce Federal and State Medicaid costs by 8.4 billion dollars over the next 5 years. “More than 90% of the cuts will be borne on the backs of community pharmacy as a result of the new AMP that cuts Medicaid reimbursement to pharmacies for generic drugs” as stated in an ACP*CN Media broadcast. In addition, this total does not include loss of bonuses and wages to hard working pharmacists and staff even though prescription numbers and total gross sales increase due to such a great loss in total profit.
Studies have shown that the current AMP model is devastating to pharmacies. The Government Accountability Office (GAO) identified the reimbursement on average is 36% less than the acquisition costs for generic medications. In congruence, the Department of Health and Human Services Office of Inspector General (OIG) stated that the average pharmacy acquisition cost for 19 of 25 high-expenditure generics are higher than what Medicaid would have reimbursed the pharmacy posing a huge loss to the pharmacy.
NCPA President John Tilley, RPh stated that “the new Medicaid AMP formula tells community pharmacies that fair and accurate reimbursement for helping economically disadvantaged patients is not a priority for the federal government.” Similarly, NCPA executive vice president and CEO Bruce Roberts, RPh stated “If the current policy is fully implemented, community pharmacies will be forced to make the impossible choice of turning their backs on vulnerable patients by dropping out of the Medicaid program or continuing in a program that threatens to bankrupt their businesses.”
Other organizations such as ACP*CN are also concerned about the new ruling stating that “this ill-conceived rule issued by CMS leaves pharmacies in the dark about how under-reimbursed they will be for generic Medicaid Drugs” and that “patient access to their neighborhood pharmacist is under assault, as the country’s healthcare delivery system teeters on the edge of destruction.” In addition, APhA has addressed the same issues regarding CMS’s ruling on AMP stating that “Pharmacists across the country may be penalized for serving Medicaid patients by the Centers for Medicare and Medicaid Services’ (CMS) new regulation for pharmacy reimbursement in the Medicaid program.”
You may view the 600 page pdf CMS ruling complete with comments from individuals and organizations and responses from CMS on GrizRPh News…they’re quite interesting. In addition please visit the following websites for additional information and full articles from: ACP*CN (http://www.acpcn.org/); NCPA (www.ncpanet.org/); and APhA (www.aphanet.org/). Please View this and more at GrizRPH.com (www.grizrph.com/).
The Centers for Medicare & Medicaid Services (CMS) have set their rules on July 6th 2007 and made them public on July 9th 2007 for viewing. Unfortunately, this rule still doesn’t provide a clear definition of Average Manufacturers Price (AMP), which is used in Medicaid’s reimbursement to pharmacies. Despite numerous attempts from pharmacists, and pharmacy organizations, Medicaid must use the new Federal Upper Limit (FUL), the maximum amount states can pay pharmacies for generic Medicaid drugs, that will be based on 250% of the lowest generic medications AMP.
This rule is part of the Deficit Reduction Act of 2005, mandating CMS to reduce Federal and State Medicaid costs by 8.4 billion dollars over the next 5 years. “More than 90% of the cuts will be borne on the backs of community pharmacy as a result of the new AMP that cuts Medicaid reimbursement to pharmacies for generic drugs” as stated in an ACP*CN Media broadcast. In addition, this total does not include loss of bonuses and wages to hard working pharmacists and staff even though prescription numbers and total gross sales increase due to such a great loss in total profit.
Studies have shown that the current AMP model is devastating to pharmacies. The Government Accountability Office (GAO) identified the reimbursement on average is 36% less than the acquisition costs for generic medications. In congruence, the Department of Health and Human Services Office of Inspector General (OIG) stated that the average pharmacy acquisition cost for 19 of 25 high-expenditure generics are higher than what Medicaid would have reimbursed the pharmacy posing a huge loss to the pharmacy.
NCPA President John Tilley, RPh stated that “the new Medicaid AMP formula tells community pharmacies that fair and accurate reimbursement for helping economically disadvantaged patients is not a priority for the federal government.” Similarly, NCPA executive vice president and CEO Bruce Roberts, RPh stated “If the current policy is fully implemented, community pharmacies will be forced to make the impossible choice of turning their backs on vulnerable patients by dropping out of the Medicaid program or continuing in a program that threatens to bankrupt their businesses.”
Other organizations such as ACP*CN are also concerned about the new ruling stating that “this ill-conceived rule issued by CMS leaves pharmacies in the dark about how under-reimbursed they will be for generic Medicaid Drugs” and that “patient access to their neighborhood pharmacist is under assault, as the country’s healthcare delivery system teeters on the edge of destruction.” In addition, APhA has addressed the same issues regarding CMS’s ruling on AMP stating that “Pharmacists across the country may be penalized for serving Medicaid patients by the Centers for Medicare and Medicaid Services’ (CMS) new regulation for pharmacy reimbursement in the Medicaid program.”
You may view the 600 page pdf CMS ruling complete with comments from individuals and organizations and responses from CMS on GrizRPh News…they’re quite interesting. In addition please visit the following websites for additional information and full articles from: ACP*CN (http://www.acpcn.org/); NCPA (www.ncpanet.org/); and APhA (www.aphanet.org/). Please View this and more at GrizRPH.com (www.grizrph.com/).
In addition, Please read the following full paged articles pertaining to CMS's AMP rulings:
.
.
.
.
.
Please feel free to share or comment on any part of CMS's AMP or any part of GrizRph.com... by using the Contact Link. Thank you.
.
Please use RPh Messenger to receive emails on updates FREE!
. Sincerely,
.
Eric Shields, PharmD
GrizRPh.com
Monday, July 2, 2007
Monthly Newsletter
HR1474, the “Prompt Payment Legislation”, has just recently been co-signed by Congressman Rehberg. This issue was previously mentioned on April 13, 2007 that you can find at GrizRPh News in the GrizRPh Archive . Thanks to all those that phoned and/or emailed Congressman Rehberg…Strong Work!!!! HR1474 was introduced to the House by Congressman Berry (AR), Jones (NC), Herseth (SD), and Wicker (SD), which is the Fair and Speedy Treatment (FAST) of Medicare Prescription Drug Claims Act of 2007. The plan calls for a 14 day turn around interval for payment (much like Medicaid) and would be very beneficial to ALL pharmacies!!!!! We need to thank Congressman Rehberg for showing his interest in continually helping pharmacists and pharmacies statewide. You can do so by visiting his email page or picking up the phone to say: “thank you for co-sponsoring HR1474 (the “Prompt Payment Legislation) and preserving the future of Montana Pharmacists”. All representative contact information can be easily accessible at www.grizrph.com/repcontact.htm .
In other news…the Montana Pharmacy Association has been working very hard to bring us all up to speed on a variety of topics including: a letter to Senator Baucus to introduce a bill to the Senate on prompt legislation such as HR1474. In addition, it would be very helpful to also include topics such as the “Community Pharmacy Fairness Act” (HR 971 as previously discussed on GrizRPh.com on April 5, 2007), which you can view at http://grizrph.blogspot.com/ … and click on April in GrizRPh Archive.
Please visit the Montana Pharmacy Association Homepage (http://www.rxmt.org/ ) to view this letter as well as: good rates on liability insurance for any individual pharmacist needing it…especially for the Montana PharmAssist program, and good news on Medicaid AMP…6 month extension at GrizRPh News or rxmt.org, and Tamper-Resistant Prescriptions to be Required for Medicaid Reimbursement as of October 1, 2007. The emergency supplemental appropriations bill (Public Law No: 110-28) that was recently passed includes a provision that effective October 1, 2007 Medicaid outpatient drugs will be reimbursable only if non-electronic written prescriptions are executed on a tamper-resistant pad. Please read more at http://www.rxmt.org/ for complete information.
Please Contact GrizRph.com for any concerns, or issues that you would like to share. GrizRPh.com is designed to be an interactive network where pharmacists and others may share information in which to speak in one voice. Please share your thoughts, ideas and concerns on how to better your network to achieve these goals. Thank you.
Sincerely,
Eric Shields, Pharm.D.
GrizRPh.com
In other news…the Montana Pharmacy Association has been working very hard to bring us all up to speed on a variety of topics including: a letter to Senator Baucus to introduce a bill to the Senate on prompt legislation such as HR1474. In addition, it would be very helpful to also include topics such as the “Community Pharmacy Fairness Act” (HR 971 as previously discussed on GrizRPh.com on April 5, 2007), which you can view at http://grizrph.blogspot.com/ … and click on April in GrizRPh Archive.
Please visit the Montana Pharmacy Association Homepage (http://www.rxmt.org/ ) to view this letter as well as: good rates on liability insurance for any individual pharmacist needing it…especially for the Montana PharmAssist program, and good news on Medicaid AMP…6 month extension at GrizRPh News or rxmt.org, and Tamper-Resistant Prescriptions to be Required for Medicaid Reimbursement as of October 1, 2007. The emergency supplemental appropriations bill (Public Law No: 110-28) that was recently passed includes a provision that effective October 1, 2007 Medicaid outpatient drugs will be reimbursable only if non-electronic written prescriptions are executed on a tamper-resistant pad. Please read more at http://www.rxmt.org/ for complete information.
Please Contact GrizRph.com for any concerns, or issues that you would like to share. GrizRPh.com is designed to be an interactive network where pharmacists and others may share information in which to speak in one voice. Please share your thoughts, ideas and concerns on how to better your network to achieve these goals. Thank you.
Sincerely,
Eric Shields, Pharm.D.
GrizRPh.com
Sunday, July 1, 2007
CMS and Medicaid AMP...6 month extension!!!
CMS Delays Implementation of Medicaid Pharmacy Rule for Six Months
[Jun 20, 2007]
CMS on Monday delayed for six months implementation of a proposed rule that would reduce Medicaid reimbursements to pharmacies for generic prescription drugs, Dow Jones reports (Wisenberg Brin, Dow Jones, 6/19). The rule, mandated by the Deficit Reduction Act of 2005, seeks to ensure that Medicaid can obtain prescription drug discounts similar to those obtained by private entities, such as pharmacy benefit managers.
Under the rule, pharmaceutical companies would have to offer Medicaid the lowest price offered to any purchaser -- which includes any "rebates, discounts or other price concessions" offered to PBMs or mail-order pharmacies. The rule also would redefine "average manufacturer price" for brand-name and generic prescription drugs. States use average manufacturer prices to calculate Medicaid reimbursement rates for prescription drugs. Rule would require the federal government to post average manufacturer prices on a Web site that consumers could access.
In addition, the rule would limit the federal share of the cost of prescription drugs when at least three generic alternatives are available. States would retain their current authority to determine Medicaid reimbursement rates to pharmacies. HHS said that the rule could reduce revenue for small pharmacies "in low-income areas where there are high concentrations of Medicaid beneficiaries." Small pharmacies could "mitigate the effects" of the rule through the purchase of lower-cost prescription drugs, HHS said. The National Community Pharmacists Association and other community pharmacy groups have argued that the rule would prompt pharmacies to end participation in Medicaid (Kaiser Daily Health Policy Report, 6/15).
CMS is scheduled to publish the final rule on July 2. Drug makers in late October are to report their September AMPs, and the adjusted Medicaid reimbursement rates for generic drugs are expected to take effect Dec. 30, according to CMS (Dow Jones, 6/19).
Potential for State Reforms
Because the rule will reduce Medicaid reimbursements to pharmacies for ingredient costs, pharmacies are hoping that states will make up the shortfall by increasing dispensing fees, the Pittsburgh Post-Gazette reports. So far, Iowa and Kansas have agreed to transfer any savings resulting from the new rule to pharmacy dispensing fees. In addition, Texas plans to increase its dispensing fee to at least $7.50, with triggers that could increase the fees to $12.50. The average dispensing fee nationwide is about $4.50.
Pat Epple of the Pennsylvania Pharmacists Association said that the $4 dispensing fee in Pennsylvania is not enough to cover the cost of doing business (Toland, Pittsburgh Post-Gazette, 6/19). Morgan Stanley analyst David Veal in a note to investors said that CMS' six-month delay will move implementation of the rule much closer to the time that many state legislatures reconvene. As a result, the delay "potentially allow[s] lawmakers to boost dispensing fees more immediately to offset the potential reimbursement cuts," Veal said (Dow Jones, 6/19).
*this excerpt was taken from the KaiserNetwork.org on 7/1/07
[Jun 20, 2007]
CMS on Monday delayed for six months implementation of a proposed rule that would reduce Medicaid reimbursements to pharmacies for generic prescription drugs, Dow Jones reports (Wisenberg Brin, Dow Jones, 6/19). The rule, mandated by the Deficit Reduction Act of 2005, seeks to ensure that Medicaid can obtain prescription drug discounts similar to those obtained by private entities, such as pharmacy benefit managers.
Under the rule, pharmaceutical companies would have to offer Medicaid the lowest price offered to any purchaser -- which includes any "rebates, discounts or other price concessions" offered to PBMs or mail-order pharmacies. The rule also would redefine "average manufacturer price" for brand-name and generic prescription drugs. States use average manufacturer prices to calculate Medicaid reimbursement rates for prescription drugs. Rule would require the federal government to post average manufacturer prices on a Web site that consumers could access.
In addition, the rule would limit the federal share of the cost of prescription drugs when at least three generic alternatives are available. States would retain their current authority to determine Medicaid reimbursement rates to pharmacies. HHS said that the rule could reduce revenue for small pharmacies "in low-income areas where there are high concentrations of Medicaid beneficiaries." Small pharmacies could "mitigate the effects" of the rule through the purchase of lower-cost prescription drugs, HHS said. The National Community Pharmacists Association and other community pharmacy groups have argued that the rule would prompt pharmacies to end participation in Medicaid (Kaiser Daily Health Policy Report, 6/15).
CMS is scheduled to publish the final rule on July 2. Drug makers in late October are to report their September AMPs, and the adjusted Medicaid reimbursement rates for generic drugs are expected to take effect Dec. 30, according to CMS (Dow Jones, 6/19).
Potential for State Reforms
Because the rule will reduce Medicaid reimbursements to pharmacies for ingredient costs, pharmacies are hoping that states will make up the shortfall by increasing dispensing fees, the Pittsburgh Post-Gazette reports. So far, Iowa and Kansas have agreed to transfer any savings resulting from the new rule to pharmacy dispensing fees. In addition, Texas plans to increase its dispensing fee to at least $7.50, with triggers that could increase the fees to $12.50. The average dispensing fee nationwide is about $4.50.
Pat Epple of the Pennsylvania Pharmacists Association said that the $4 dispensing fee in Pennsylvania is not enough to cover the cost of doing business (Toland, Pittsburgh Post-Gazette, 6/19). Morgan Stanley analyst David Veal in a note to investors said that CMS' six-month delay will move implementation of the rule much closer to the time that many state legislatures reconvene. As a result, the delay "potentially allow[s] lawmakers to boost dispensing fees more immediately to offset the potential reimbursement cuts," Veal said (Dow Jones, 6/19).
*this excerpt was taken from the KaiserNetwork.org on 7/1/07
The 6 month extention was due mainly to ACP*CN as well as other organizations concerned about the complexity of the rule being put into effect when legislation is not in session and its devasting effect on retail pharmacies. You can view ACP*CN's letter to Leslie Norwalk written on May 18th, 2007.
Tuesday, May 29, 2007
Thank You From Tobey!
I want to thank you for putting this site together. You have done a wonderful job.
I also would like to express how humbling it is to receive the thank you's from everyone. I feel that everyone is doing important things in their work and home environment.
I feel that I was just fortunate that Senator Baucus and his staff had the confidence in me to be able to tell the story of my patients and pharmacy during this Medicare Part D adventure. I am sure that all of you would have done the same had the opportunity come along.
I encourage everyone to get active and give productive suggestions how to improve our profession. I feel that we are at a very critical point in our profession and everyone must come together and speak as one.
Thank you again for providing this site.
My best to you,
Tobey Schule
I also would like to express how humbling it is to receive the thank you's from everyone. I feel that everyone is doing important things in their work and home environment.
I feel that I was just fortunate that Senator Baucus and his staff had the confidence in me to be able to tell the story of my patients and pharmacy during this Medicare Part D adventure. I am sure that all of you would have done the same had the opportunity come along.
I encourage everyone to get active and give productive suggestions how to improve our profession. I feel that we are at a very critical point in our profession and everyone must come together and speak as one.
Thank you again for providing this site.
My best to you,
Tobey Schule
Monday, May 21, 2007
Special Thanks to Tobey Schule and Timothy Tucker
Thanks to Tobey Schule, RPh, co-owner of Sykes Drug in Kalispell, and Timothy Tucker, PharmD, American Pharmacy Association President-Elect, the voice of pharmacy was heard in Congress on May 2nd before the Committee on Finance, United States Senate. Tobey did a wonderful job of speaking first hand on the impact that Medicare D has had on Sykes Drug, as well as the impact it has had on his patients. Tobey shared his concerns for his patient’s welfare if Medicare were to continue on the course it has with slow reimbursement, PBM formulary mandates and changes, donut-hole catastrophes, forcing of mail order by PBMs, and the overwhelming control of the PBMs on patient care. In addition, Tobey also gave statements for Medication Therapy Management (MTM) to be done face to face through pharmacist-patient pharmaceutical care and the need to recognize pharmacists as providers. Please read Tobey’s very compelling and very heart felt testimony. Thank you Tobey…we couldn’t have had a better representative. Please read Tobey’s May 2, 2007 testimony, which is also posted on the Montana Pharmacy Association Website along with Timothy Tucker's testimony.
In addition, you may read for your enjoyment Tobey’s February 2006 statement to Congress, as well as the Missoula Independent Record’s comments on the May 2nd hearing posted May 17, 2007.
Second, please read through Timothy Tuckers testimony to the Senate Committee on Finance on May 2nd about the impact on pharmacy as a whole with the results from several surveys conducted by the American Pharmacy Association in 2006. Timothy discusses a multitude of important topics with corrective suggestions including: unfair “negotiations” pertaining to the antitrust law, slow and low reimbursement from PBMs, electronic funds transfers, Plan-to-Plan Claim Reconciliation, formulary management, importance of patient pharmacist MTM, enrollment and eligibility, as well as operational issues. Thank you Timothy and APhA for addressing these issues and providing solutions…strong work!!!
Thanks to both Tobey and Timothy, the voice of pharmacy was heard collectively about the same issues and its dramatic effects on pharmacy today. Let’s show our appreciation by simply telling them Thank You!!! I will post your thank you and comments on GrizRPh.com so they may see them. I will post the letter in “In The Spotlight” section of GrizRPh.com. CLICK HERE to sign or leave your message. Thank You!!!
Sincerely,
Eric Shields, PharmD
GrizRPh.com
In addition, you may read for your enjoyment Tobey’s February 2006 statement to Congress, as well as the Missoula Independent Record’s comments on the May 2nd hearing posted May 17, 2007.
Second, please read through Timothy Tuckers testimony to the Senate Committee on Finance on May 2nd about the impact on pharmacy as a whole with the results from several surveys conducted by the American Pharmacy Association in 2006. Timothy discusses a multitude of important topics with corrective suggestions including: unfair “negotiations” pertaining to the antitrust law, slow and low reimbursement from PBMs, electronic funds transfers, Plan-to-Plan Claim Reconciliation, formulary management, importance of patient pharmacist MTM, enrollment and eligibility, as well as operational issues. Thank you Timothy and APhA for addressing these issues and providing solutions…strong work!!!
Thanks to both Tobey and Timothy, the voice of pharmacy was heard collectively about the same issues and its dramatic effects on pharmacy today. Let’s show our appreciation by simply telling them Thank You!!! I will post your thank you and comments on GrizRPh.com so they may see them. I will post the letter in “In The Spotlight” section of GrizRPh.com. CLICK HERE to sign or leave your message. Thank You!!!
Sincerely,
Eric Shields, PharmD
GrizRPh.com
Tuesday, May 8, 2007
Montana PharmAssist is Coming!!!
Just a quick Memo to remind everyone that if you haven’t already received your PharmAssist Training Program materials from the University of Montana, to please sign up now for the upcoming programs on: June 24th in Kalispell, August 19th in Great Falls, and October 14th in Missoula. Missoula is already receiving the “Green Cards” in the mail that have email contact information in which to receive a pdf form via email that you must fill out and fax in. To save everyone some extra work and time, just CLICK HERE to download the form in pdf format (get adobe acrobat reader, if needed), quickly fill it out and fax it in right from work…it will just take a few minutes. Hurry spots are filling quickly! Please fax signed form to:
ACPE Program Assistant, 406-243-4353 (Fax #)
Please e-mail any questions to:
pharmacy.ce@umontana.edu
or call 406-243-2453 (Phone #)
.
Answers to some posing questions:
1. Yes, you get 6 Free CE credits for the program
2. Yes, the program itself is Free!!!
3. No, you do not have to have proof of Personal Liability Insurance to attend the CE or get certification. You will need Personal Liability Insurance before meeting your first patient.
4. No, pharmacies are not reimbursed through the Program; Only Pharmacists are personally reimbursed.
5. Yes, the program is very educational and fulfilling!!!
Answers to some posing questions:
1. Yes, you get 6 Free CE credits for the program
2. Yes, the program itself is Free!!!
3. No, you do not have to have proof of Personal Liability Insurance to attend the CE or get certification. You will need Personal Liability Insurance before meeting your first patient.
4. No, pharmacies are not reimbursed through the Program; Only Pharmacists are personally reimbursed.
5. Yes, the program is very educational and fulfilling!!!
.
The Following letter is from Roger Citron, RPh at DPHHS, that I found lying around, explaining the Montana Pharmacist Program:
February 13, 2007
Dear Montana Pharmacist,
The Montana PharmAssist is coming! The Montana Department of Public Health and Human Services (DPHHS) is offering all Montana pharmacists the opportunity to become credentialed to participate in this new program. Based upon the Wyoming PharmAssist (see website below), DPHHS developed the program framework tailored to meet the needs of our Montana residents.
The University of Montana Skaggs School of Pharmacy will offer six hours of free continuing education (CE) to train pharmacists intent on participating in the program. Only credentialed pharmacists may provide and be paid for these cognitive services through the Montana PharmAssist.
Once our credentialed provider base is trained the program will be advertised to the public, with the intent to begin processing requests in July, 2007. Any Montana resident will be eligible to request a consultation through the PharmAssist. The Mountain-Pacific Quality Health Foundation will review these patient applications and then coordinate a one-to-one counseling session to be performed by one of the credentialed pharmacists.
The final rules for this new program are still in work, but DPHHS is planning to utilize personal service contracts for credentialed pharmacists (not pharmacies) to get reimbursed when they provide these services.
As a profession, we must look for innovative ways to get reimbursed for our clinical skills and knowledge.
The Montana PharmAssist is a start. I urge you to consider registering for one of the training sessions to be able to participate in this exciting, innovative program.
Sincerely,
Roger A. Citron, R.Ph.
Montana Medicaid Pharmacist
Montana Department of Public Health & Human Services
(406)444-5951
rcitron@mt.gov
Here is the example of the Wyoming PharmAssist Program Roger had mentioned that the Montana PharmAssist program is modeled after: Wyoming PharmAssist Program
Thursday, April 19, 2007
Recap on Current Events!!!
Please visit the Montana Pharmacy Association Website for information regarding the PharmAssist program. As a reminder, the second PharmAssist CE session (6 CE credits) will be held in Billings, MT Sunday, April 29th at the Holiday Inn. Please visit www.rxmt.org to sign up for PharmAssist and learn how pharmacists can get reimbursed for managed care. In addition, please read the following response to Dr. Manasse, Executive Vice President of ASHP, by Vince Colucci, Pharm.D., BCPS, Associate Professor, The University of Montana CHPBS, President, Montana Pharmacy Association, in regards to MPA’s affiliation status with ASHP.
Good NEWS!!! Just in case you haven’t heard yet, a couple of bad bills including SB397, the clinic medical practitioner dispensing bill, and SB 521, the bill that would revise pharmacy laws to prohibit substitution of anticonvulsants without consent of both the prescriber and the patient, have been tabled. In addition, the “Medicaid Reimbursement Scare” is over for now. The 60th Legislative session is now at an end and Medicaid reimbursement will remain the same! Please give all your thanks to: Becky Deschamps, Starla Blank, Brett Stubson, Mark Meredith, and Jim Smith, for all their legislative efforts! It was a rough pharmacy session, but they pulled through for us. Thank you!!! In addition, thank you to all of you who have contributed by writing letters to the appropriate House and Senate members, and for those that have spread the word about pertinent legislative issues to protect our futures. Thank you!!!
In Federal news, please thank Senator Baucus for all his support in pharmacy legislation and protecting the pharmacy practice! In addition, please thank Congressman Rehberg for co-sponsoring HR1474, the Fair & Speedy Treatment Act. This act will push PBM’s to pay pharmacies within a 14 day interval rather than a month to three month interval. This way, pharmacies can relax on making the budget work and concentrate more on better pharmacy services and no one loses their pharmacy or their job. You will find a copy of the official letter stating Rehberg’s co-sponsoring of HR1474 on www.rxmt.org and www.grizrph.com when applicable. Please use the links on GrizRPh.com (Representative Contacts) to write or phone your representatives today to say THANK YOU!!! To read more about the current legislative issues and pharmacy topics, please visit the Montana Pharmacy Association (www.rxmt.org) or GrizRph.com (www.grizrph.com). Thank you all for your support!!!
Sincerely,
GrizRPh.com
Good NEWS!!! Just in case you haven’t heard yet, a couple of bad bills including SB397, the clinic medical practitioner dispensing bill, and SB 521, the bill that would revise pharmacy laws to prohibit substitution of anticonvulsants without consent of both the prescriber and the patient, have been tabled. In addition, the “Medicaid Reimbursement Scare” is over for now. The 60th Legislative session is now at an end and Medicaid reimbursement will remain the same! Please give all your thanks to: Becky Deschamps, Starla Blank, Brett Stubson, Mark Meredith, and Jim Smith, for all their legislative efforts! It was a rough pharmacy session, but they pulled through for us. Thank you!!! In addition, thank you to all of you who have contributed by writing letters to the appropriate House and Senate members, and for those that have spread the word about pertinent legislative issues to protect our futures. Thank you!!!
In Federal news, please thank Senator Baucus for all his support in pharmacy legislation and protecting the pharmacy practice! In addition, please thank Congressman Rehberg for co-sponsoring HR1474, the Fair & Speedy Treatment Act. This act will push PBM’s to pay pharmacies within a 14 day interval rather than a month to three month interval. This way, pharmacies can relax on making the budget work and concentrate more on better pharmacy services and no one loses their pharmacy or their job. You will find a copy of the official letter stating Rehberg’s co-sponsoring of HR1474 on www.rxmt.org and www.grizrph.com when applicable. Please use the links on GrizRPh.com (Representative Contacts) to write or phone your representatives today to say THANK YOU!!! To read more about the current legislative issues and pharmacy topics, please visit the Montana Pharmacy Association (www.rxmt.org) or GrizRph.com (www.grizrph.com). Thank you all for your support!!!
Sincerely,
GrizRPh.com
Friday, April 13, 2007
Prompt Payment Legislation
Late Medicare Part D payments have forced independent pharmacies to borrow tens of thousands of dollars every month to cover payroll, wholesaler bills, and other basic operating costs.
HR1474 was just introduced to the the House by Congressman Berry (AR), Jones (NC), Herseth (SD), and Wicker (SD), which is the Fair and Speedy Treatment (FAST) of Medicare Prescription Drug Claims Act of 2007. The plan calls for a 14 day turn around interval for payment (much like Medicaid) and would be very beneficial to ALL pharmacies!!!!! We should urge Congressman Rehberg to co-sponsor HR1474
1. Tell Rehberg's staff that prompt payment legislation is critical so that pharmacists providing care to Part D patients are reimbursed in a timely fashion. Right now, the federal government pays the prescription drug plans up front, and they in turn retain this money for as long as possible, making interest on taxpayer dollars. Meanwhile, community pharmacies are forced to borrow tens of thousands of dollars in order to bank the Part D program. Unless something is done soon, patient access to community pharmacy is going to be seriously jeopardized.
2. Tell Rehberg's staff that immediate action is needed to ensure our independent pharmacists are not forced out of business by low and slow reimbursement.
3. Urge Rehberg to Co-Sponsor HR1474 and see where he stands on this issue.
You may use this link to contact Rehberg, or call his offices at (406) 256-1019.
Thanks to NCPA for awareness on this issue.
HR1474 was just introduced to the the House by Congressman Berry (AR), Jones (NC), Herseth (SD), and Wicker (SD), which is the Fair and Speedy Treatment (FAST) of Medicare Prescription Drug Claims Act of 2007. The plan calls for a 14 day turn around interval for payment (much like Medicaid) and would be very beneficial to ALL pharmacies!!!!! We should urge Congressman Rehberg to co-sponsor HR1474
1. Tell Rehberg's staff that prompt payment legislation is critical so that pharmacists providing care to Part D patients are reimbursed in a timely fashion. Right now, the federal government pays the prescription drug plans up front, and they in turn retain this money for as long as possible, making interest on taxpayer dollars. Meanwhile, community pharmacies are forced to borrow tens of thousands of dollars in order to bank the Part D program. Unless something is done soon, patient access to community pharmacy is going to be seriously jeopardized.
2. Tell Rehberg's staff that immediate action is needed to ensure our independent pharmacists are not forced out of business by low and slow reimbursement.
3. Urge Rehberg to Co-Sponsor HR1474 and see where he stands on this issue.
You may use this link to contact Rehberg, or call his offices at (406) 256-1019.
Thanks to NCPA for awareness on this issue.
Wednesday, April 11, 2007
CMS Ruling on Competative Bidding for DME!
Way to go NCPA!!!
April 10th, 2007 CMS rule on competative bidding for durable medical equipment ensures medicare patients' continued access to diabetes testing products at their local pharmacies. Just in case you missed the immediate release note from NCPA on this ruling...you can read it here. Click Here to read more.
April 10th, 2007 CMS rule on competative bidding for durable medical equipment ensures medicare patients' continued access to diabetes testing products at their local pharmacies. Just in case you missed the immediate release note from NCPA on this ruling...you can read it here. Click Here to read more.
Monday, April 9, 2007
CMS and AMP
NEW!!!! Read the letters to the Acting Administrator of Centers of Medicare and Medicaid Services, Leslie Norwalk, regarding CMS's ruling on pharmacy reimbursement located at "In the Spotlight."
In addition, read an outstanding article published by Faith Bremner from the Tribune Washington Bureau, that made the front page of the Great Falls Tribune on April 9th, 2007 regarding CMS's ruling on pharmacy reimbursement and its effects on independent pharmacies. Click Here to read more.
In addition, read an outstanding article published by Faith Bremner from the Tribune Washington Bureau, that made the front page of the Great Falls Tribune on April 9th, 2007 regarding CMS's ruling on pharmacy reimbursement and its effects on independent pharmacies. Click Here to read more.
Thursday, April 5, 2007
CMS Proposed Regulation of AMP!!!!!!
Just in!!!!!
Thanks to Jim Smith, Executive Director of MPA, we have a copy of the CMS proposed regulation of AMP provided by the National Association of State Medicaid Directors and the American Public Human Services Association, that was provided by Reginia Grayson Benjamin, Esq. Director, Government Affairs (State) National Community Pharmacists Association (www.ncpanet.org ). Unfortunately, it is too large to put on the blog in full text, so I've placed in on the server at http://www.grizrph.com, and you may use the "CMS proposed regulation of AMP" link to get there( it's a must read). You may need Adobe Acrobat Reader to read it.
Sincerely,
GrizRPh.com
Thanks to Jim Smith, Executive Director of MPA, we have a copy of the CMS proposed regulation of AMP provided by the National Association of State Medicaid Directors and the American Public Human Services Association, that was provided by Reginia Grayson Benjamin, Esq. Director, Government Affairs (State) National Community Pharmacists Association (www.ncpanet.org ). Unfortunately, it is too large to put on the blog in full text, so I've placed in on the server at http://www.grizrph.com, and you may use the "CMS proposed regulation of AMP" link to get there( it's a must read). You may need Adobe Acrobat Reader to read it.
Sincerely,
GrizRPh.com
Federal Issues...HR 971 'Community Pharmacy Fairness Act of 2007'
HR 971 is a bill that we need all of our Representatives (Baucus, Tester, and Rehberg) to CO-SPONSOR. The ‘Community Pharmacy Fairness Act of 2007' (HR 971) was introduced in Congress to eliminate the anti-trust barriers that prevent small and independent pharmacies from negotiating together when they seek agreements with powerful Pharmacy Benefit Managers (PBMs). By banding together, independent pharmacies would have greater leverage to negotiate reimbursement rates, payment options, and other details of contracts. This would establish a balanced playing field between pharmacies and PBMs, would reduce the pressure on the government to regulate reimbursement rates, and reduce prices for consumers. HR 971 would also address problems under the current "take it or leave it" system which is very harmful to our customers and us as well. Similar legislation passed the House of Representatives in 2000; let’s make sure that this one sticks as well.
I’ve spoken with the Missoula offices of Congressman Rehberg, Senator Baucus, and Senator Tester; however, they could not tell me their position on the bill and were not familiar with HR 971.
I’m urging you to contact your representatives and let them know your vote to CO-SPONSOR HR 971 to let independent pharmacies join together to negotiate reimbursement rates, payment options, and other contract details.
All you need to do is give them your vote that we support HR 971 and to CO-SPONSOR THE BILL. Please don’t hesitate; phone, email, or fax your statements to their offices.
Baucus ; or other contact info provided by ACP*CN...click here
Rehberg ; or other contact info provided by ACP*CN...click here
Tester ; or other contact info provided by ACP*CN...click here
Read more about HR 971 at ACP*CN website!
Sincerely,
GrizRPh.com
BILL TEXT
HR 971: Community Pharmacy Fairness Act of 2007 (Introduced in House)
110th CONGRESS
1st Session
H. R. 971
To ensure and foster continued patient safety and quality of care by making the antitrust laws apply to negotiations between groups of independent pharmacies and health plans and health insurance issuers (including health plans under parts C and D of the Medicare Program) in the same manner as such laws apply to protected activities under the National Labor Relations Act.
IN THE HOUSE OF REPRESENTATIVES
February 8, 2007
Mr. WEINER (for himself and Mr. MORAN of Kansas) introduced the following bill; which was referred to the Committee on the Judiciary
A BILL
To ensure and foster continued patient safety and quality of care by making the antitrust laws apply to negotiations between groups of independent pharmacies and health plans and health insurance issuers (including health plans under parts C and D of the Medicare Program) in the same manner as such laws apply to protected activities under the National Labor Relations Act.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Community Pharmacy Fairness Act of 2007'.
SEC. 2. APPLICATION OF THE ANTITRUST LAWS TO INDEPENDENT PHARMACIES NEGOTIATING WITH HEALTH PLANS.
(a) In General- Any independent pharmacies who are engaged in negotiations with a health plan regarding the terms of any contract under which the pharmacies provide health care items or services for which benefits are provided under such plan shall, in connection with such negotiations, be entitled to the same treatment under the antitrust laws as the treatment to which bargaining units which are recognized under the National Labor Relations Act are entitled in connection with activities described in section 7 of such Act. Such a pharmacy shall, only in connection with such negotiations, be treated as an employee engaged in concerted activities and shall not be regarded as having the status of an employer, independent contractor, managerial employee, or supervisor.
(b) Protection for Good Faith Actions- Actions taken in good faith reliance on subsection (a) shall not be the subject under the antitrust laws of criminal sanctions nor of any civil damages, fees, or penalties beyond actual damages incurred.
(c) No Change in National Labor Relations Act- This section applies only to independent pharmacies excluded from the National Labor Relations Act. Nothing in this section shall be construed as changing or amending any provision of the National Labor Relations Act, or as affecting the status of any group of persons under that Act.
(d) Effective Date- The exemption provided in subsection (a) shall apply to conduct occurring beginning on the date of the enactment of this Act.
(e) Limitation on Exemption- Nothing in this section shall exempt from the application of the antitrust laws any agreement or otherwise unlawful conspiracy that excludes, limits the participation or reimbursement of, or otherwise limits the scope of services to be provided by any independent pharmacy or group of independent pharmacies with respect to the performance of services that are within their scope of practice as defined or permitted by relevant law or regulation.
(f) No Effect on Title VI of Civil Rights Act of 1964- Nothing in this section shall be construed to affect the application of title VI of the Civil Rights Act of 1964.
(g) No Application to Specified Federal Programs- Nothing in this section shall apply to negotiations between independent pharmacies and health plans pertaining to benefits provided under any of the following:
(1) The Medicaid Program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
(2) The State Children's Health Insurance Program (SCHIP) under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.).
(3) Chapter 55 of title 10, United States Code (relating to medical and dental care for members of the uniformed services).
(4) Chapter 17 of title 38, United States Code (relating to Veterans' medical care).
(5) Chapter 89 of title 5, United States Code (relating to the Federal employees' health benefits program).
(6) The Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.).
(h) Definitions- For purposes of this section:
(1) ANTITRUST LAWS- The term `antitrust laws'--
(A) has the meaning given it in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)), except that such term includes section 5 of the Federal Trade Commission Act (15 U.S.C. 45) to the extent such section 5 applies to unfair methods of competition; and
(B) includes any State law similar to the laws referred to in subparagraph (A).
(2) HEALTH PLAN AND RELATED TERMS-
(A) IN GENERAL- The term `health plan'--
(i) means a group health plan or a health insurance issuer that is offering health insurance coverage;
(ii) includes a prescription drug plan offered under part D of title XVIII of the Social Security Act and a Medicare Advantage plan offered under part C of such title; and
(iii) includes any entity that contracts with such a plan or issuer for the administering of services under the plan or coverage.
(B) HEALTH INSURANCE COVERAGE; HEALTH INSURANCE ISSUER- The terms `health insurance coverage' and `health insurance issuer' have the meanings given such terms under paragraphs (1) and (2), respectively, of section 733(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191b(b)).
(C) GROUP HEALTH PLAN- The term `group health plan' has the meaning given that term in section 733(a)(1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191b(a)(1)).
(3) INDEPENDENT PHARMACY- The term `independent pharmacy' means a pharmacy which is not owned (or operated) by a publicly traded company. For purposes of the previous sentence, the term `publicly traded company' means a company that is an issuer within the meaning of section 2(a)(7) of the Sarbanes-Oxley Act of 2002 (15 U.S.C. 7201(a)(7)).
*Bill text taken from ACP*CN website and posted here for easy access and reading. Thanks ACP*CN for all your hardwork!
I’ve spoken with the Missoula offices of Congressman Rehberg, Senator Baucus, and Senator Tester; however, they could not tell me their position on the bill and were not familiar with HR 971.
I’m urging you to contact your representatives and let them know your vote to CO-SPONSOR HR 971 to let independent pharmacies join together to negotiate reimbursement rates, payment options, and other contract details.
All you need to do is give them your vote that we support HR 971 and to CO-SPONSOR THE BILL. Please don’t hesitate; phone, email, or fax your statements to their offices.
Baucus ; or other contact info provided by ACP*CN...click here
Rehberg ; or other contact info provided by ACP*CN...click here
Tester ; or other contact info provided by ACP*CN...click here
Read more about HR 971 at ACP*CN website!
Sincerely,
GrizRPh.com
BILL TEXT
HR 971: Community Pharmacy Fairness Act of 2007 (Introduced in House)
110th CONGRESS
1st Session
H. R. 971
To ensure and foster continued patient safety and quality of care by making the antitrust laws apply to negotiations between groups of independent pharmacies and health plans and health insurance issuers (including health plans under parts C and D of the Medicare Program) in the same manner as such laws apply to protected activities under the National Labor Relations Act.
IN THE HOUSE OF REPRESENTATIVES
February 8, 2007
Mr. WEINER (for himself and Mr. MORAN of Kansas) introduced the following bill; which was referred to the Committee on the Judiciary
A BILL
To ensure and foster continued patient safety and quality of care by making the antitrust laws apply to negotiations between groups of independent pharmacies and health plans and health insurance issuers (including health plans under parts C and D of the Medicare Program) in the same manner as such laws apply to protected activities under the National Labor Relations Act.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Community Pharmacy Fairness Act of 2007'.
SEC. 2. APPLICATION OF THE ANTITRUST LAWS TO INDEPENDENT PHARMACIES NEGOTIATING WITH HEALTH PLANS.
(a) In General- Any independent pharmacies who are engaged in negotiations with a health plan regarding the terms of any contract under which the pharmacies provide health care items or services for which benefits are provided under such plan shall, in connection with such negotiations, be entitled to the same treatment under the antitrust laws as the treatment to which bargaining units which are recognized under the National Labor Relations Act are entitled in connection with activities described in section 7 of such Act. Such a pharmacy shall, only in connection with such negotiations, be treated as an employee engaged in concerted activities and shall not be regarded as having the status of an employer, independent contractor, managerial employee, or supervisor.
(b) Protection for Good Faith Actions- Actions taken in good faith reliance on subsection (a) shall not be the subject under the antitrust laws of criminal sanctions nor of any civil damages, fees, or penalties beyond actual damages incurred.
(c) No Change in National Labor Relations Act- This section applies only to independent pharmacies excluded from the National Labor Relations Act. Nothing in this section shall be construed as changing or amending any provision of the National Labor Relations Act, or as affecting the status of any group of persons under that Act.
(d) Effective Date- The exemption provided in subsection (a) shall apply to conduct occurring beginning on the date of the enactment of this Act.
(e) Limitation on Exemption- Nothing in this section shall exempt from the application of the antitrust laws any agreement or otherwise unlawful conspiracy that excludes, limits the participation or reimbursement of, or otherwise limits the scope of services to be provided by any independent pharmacy or group of independent pharmacies with respect to the performance of services that are within their scope of practice as defined or permitted by relevant law or regulation.
(f) No Effect on Title VI of Civil Rights Act of 1964- Nothing in this section shall be construed to affect the application of title VI of the Civil Rights Act of 1964.
(g) No Application to Specified Federal Programs- Nothing in this section shall apply to negotiations between independent pharmacies and health plans pertaining to benefits provided under any of the following:
(1) The Medicaid Program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
(2) The State Children's Health Insurance Program (SCHIP) under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.).
(3) Chapter 55 of title 10, United States Code (relating to medical and dental care for members of the uniformed services).
(4) Chapter 17 of title 38, United States Code (relating to Veterans' medical care).
(5) Chapter 89 of title 5, United States Code (relating to the Federal employees' health benefits program).
(6) The Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.).
(h) Definitions- For purposes of this section:
(1) ANTITRUST LAWS- The term `antitrust laws'--
(A) has the meaning given it in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)), except that such term includes section 5 of the Federal Trade Commission Act (15 U.S.C. 45) to the extent such section 5 applies to unfair methods of competition; and
(B) includes any State law similar to the laws referred to in subparagraph (A).
(2) HEALTH PLAN AND RELATED TERMS-
(A) IN GENERAL- The term `health plan'--
(i) means a group health plan or a health insurance issuer that is offering health insurance coverage;
(ii) includes a prescription drug plan offered under part D of title XVIII of the Social Security Act and a Medicare Advantage plan offered under part C of such title; and
(iii) includes any entity that contracts with such a plan or issuer for the administering of services under the plan or coverage.
(B) HEALTH INSURANCE COVERAGE; HEALTH INSURANCE ISSUER- The terms `health insurance coverage' and `health insurance issuer' have the meanings given such terms under paragraphs (1) and (2), respectively, of section 733(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191b(b)).
(C) GROUP HEALTH PLAN- The term `group health plan' has the meaning given that term in section 733(a)(1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191b(a)(1)).
(3) INDEPENDENT PHARMACY- The term `independent pharmacy' means a pharmacy which is not owned (or operated) by a publicly traded company. For purposes of the previous sentence, the term `publicly traded company' means a company that is an issuer within the meaning of section 2(a)(7) of the Sarbanes-Oxley Act of 2002 (15 U.S.C. 7201(a)(7)).
*Bill text taken from ACP*CN website and posted here for easy access and reading. Thanks ACP*CN for all your hardwork!
Monday, April 2, 2007
Strong Work Everyone!!!
Thank you Becky for the following update! Good work everybody!
Good Monday...
In case you haven't heard, SB397 (the bill would have allowed routine dispensing of drugs by medical practitioners at employer-based onsite clinics) and SB521 (the bill to prohibit substitution of anticonvulsants without the consent of both the prescriber and the patient) were both tabled in the House Human Services committee last week. While it's possible that the bills could be resurrected it's highly unlikely, as that would require a reversal of the votes from last week. The bills are essentially dead, thanks to all of you!
Some of you called legislators you knew that were on the committee, some of you wrote, and some of you sent an e-mail message, and as a result every member of the House Human Services committee heard from at least one pharmacist, and some heard from many. You all did what you could and notified others, and you accomplished what was seemingly impossible!
SB397 had passed the Senate on a 50-0 vote and was stopped cold in committee in the House, while SB521 passed the Senate on a 48-2 vote and met the same fate in the same committee. Please take a second to call, write or e-mail the committee members you previously contacted and thank them for their wise vote to table both of these bills. Also, please spread the word to others that helped but don't have e-mail. I'll try to call them too.
I received a nice e-mail from Jim Smith of MPA, thanking all of you for your help. This wouldn't have happened without you!
I've printed the list of committee members below, and want to thank each one of you again for your excellent work!
Thanks.....
Becky Deschamps, RPh
Stoker, Ron – Darby (no pharmacy) (Becky will call Wayne Hedman in Hamilton and others)
McGillvray, Tom – Billings Shannon Robison 656-8188
Becker, Arlene – Billings Margie nafts 237-8100
Caferro, Mary - Helena
Dutton, Ernie – Billings Dan Jurovich 259-2562
French, Julie – Scobey Robert Haugo 487-5911
Ingraham, Pat – Thompson Falls S. Shear 827-4349
Jones, Bill – Conrad Jesse Parks 278-3267 Peter McKeone 271-3211
Kerns, Krayton - Laurel Carl Wallila 628-8747, John Barsness 628-7217, Robert Baldner 628-6022
McAlpin, David - Missoula
Milburn, Mike – Cascade (no pharmacy)
Peterson, Ken – Billings Ed Kent 657-4155
Reinhart, Michele - Missoula
Sands, Diane - Missoula
Good Monday...
In case you haven't heard, SB397 (the bill would have allowed routine dispensing of drugs by medical practitioners at employer-based onsite clinics) and SB521 (the bill to prohibit substitution of anticonvulsants without the consent of both the prescriber and the patient) were both tabled in the House Human Services committee last week. While it's possible that the bills could be resurrected it's highly unlikely, as that would require a reversal of the votes from last week. The bills are essentially dead, thanks to all of you!
Some of you called legislators you knew that were on the committee, some of you wrote, and some of you sent an e-mail message, and as a result every member of the House Human Services committee heard from at least one pharmacist, and some heard from many. You all did what you could and notified others, and you accomplished what was seemingly impossible!
SB397 had passed the Senate on a 50-0 vote and was stopped cold in committee in the House, while SB521 passed the Senate on a 48-2 vote and met the same fate in the same committee. Please take a second to call, write or e-mail the committee members you previously contacted and thank them for their wise vote to table both of these bills. Also, please spread the word to others that helped but don't have e-mail. I'll try to call them too.
I received a nice e-mail from Jim Smith of MPA, thanking all of you for your help. This wouldn't have happened without you!
I've printed the list of committee members below, and want to thank each one of you again for your excellent work!
Thanks.....
Becky Deschamps, RPh
Stoker, Ron – Darby (no pharmacy) (Becky will call Wayne Hedman in Hamilton and others)
McGillvray, Tom – Billings Shannon Robison 656-8188
Becker, Arlene – Billings Margie nafts 237-8100
Caferro, Mary - Helena
Dutton, Ernie – Billings Dan Jurovich 259-2562
French, Julie – Scobey Robert Haugo 487-5911
Ingraham, Pat – Thompson Falls S. Shear 827-4349
Jones, Bill – Conrad Jesse Parks 278-3267 Peter McKeone 271-3211
Kerns, Krayton - Laurel Carl Wallila 628-8747, John Barsness 628-7217, Robert Baldner 628-6022
McAlpin, David - Missoula
Milburn, Mike – Cascade (no pharmacy)
Peterson, Ken – Billings Ed Kent 657-4155
Reinhart, Michele - Missoula
Sands, Diane - Missoula
Sunday, March 25, 2007
Testimonies of Inspiration
Dear Pharmacies,
The Deadline is getting closer and we're running out of time to Table SB397. We must act now to contact our representatives. SB397 has gotten pushed through the Senate and is almost through the House almost as to avoid opposition. No one realized it was even introduced to the Senate until it was too late! I have left you email links to each of the three Missoula representatives at the end of this message... please do your part. You may simply write to them saying that you are opposed to SB397 and fear for patient safety concerns and to please "table SB397" or you may address your own concerns such as why an insurance company is trying to push a bill through legislation only to save a few bucks for themselves while the clinic staff, pharmacies, and worst of all the patients get the shaft! I have attached a letter from a concerned pharmacist stating their concerns as a good example:
Dear Rep. Kerns:
I am asking you to please oppose SB 397. This bill would permit physicians to dispense medications at employer-based clinics. Although this may sound like a good idea at first, taking pharmacists out of the drug distribution system creates serious problems. Pharmacists provide a safety net for medication use, including providing the correct medication at the correct dose and screening for medication allergies, Pharmacists also screen for drug interactions with other prescriptions, over-the-counter medications, nutritional supplements, and herbal products. The pharmacist may have to compound special preparations, such as skin creams or ointments, or mix liquid antibiotics. Pharmacists educate patients about the correct use of medications and how to deal with possible side effects. Upon identifying any actual or potential medication-related problems, a pharmacist will contact the physician to make recommendations and find an appropriate solution. Physicians have a limited amount of time in which to assess a patient by listening to the patient’s problems, performing a history and physical examination, making a tentative diagnosis, ordering laboratory tests, deciding on appropriate treatment, and educating the patient about the treatment plan. They really don’t have time to adequately perform the additional tasks performed by a pharmacist, who have trained for at least 6 years to understand the nuances of medications. An employer-based clinic has a limited choice of mostly generic medications available for dispensing and no controlled substances. This often requires a patient to go to a local pharmacy for some, if not all, of his or her prescriptions. Local pharmacies are often less expensive because of bulk purchasing and special pricing. There are hundreds of medication-related problems and errors prevented by pharmacists every day, saving enormous costs by avoiding hospital and emergency room visits, serious side effects, and even deaths. Please vote no on SB 397 to keep patients at employer-based clinics safe from the many potential dangers of medications.
Please use the following links to contact Missoula's representatives on the House Committee.
Michele Reinhart HD97 MICHELEREINHART@GMAIL.COM
Dave McAlpin HD94 MCDAVE94@HOTMAIL.COM
Diane Sands HD95 HDSANDS@AOL.COM
Just let your representative know your vote: that you oppose the bill and to "TABLE SB397" thats all that's needed! Becky, Jim, and Starla need our support. Thank you!
For more information pertaining to these bills visit: Montana State Legislation for Bill information, and GrizRPh Current Legislation for a break down of what is happening in Helena with SB397 and more!
The Deadline is getting closer and we're running out of time to Table SB397. We must act now to contact our representatives. SB397 has gotten pushed through the Senate and is almost through the House almost as to avoid opposition. No one realized it was even introduced to the Senate until it was too late! I have left you email links to each of the three Missoula representatives at the end of this message... please do your part. You may simply write to them saying that you are opposed to SB397 and fear for patient safety concerns and to please "table SB397" or you may address your own concerns such as why an insurance company is trying to push a bill through legislation only to save a few bucks for themselves while the clinic staff, pharmacies, and worst of all the patients get the shaft! I have attached a letter from a concerned pharmacist stating their concerns as a good example:
Dear Rep. Kerns:
I am asking you to please oppose SB 397. This bill would permit physicians to dispense medications at employer-based clinics. Although this may sound like a good idea at first, taking pharmacists out of the drug distribution system creates serious problems. Pharmacists provide a safety net for medication use, including providing the correct medication at the correct dose and screening for medication allergies, Pharmacists also screen for drug interactions with other prescriptions, over-the-counter medications, nutritional supplements, and herbal products. The pharmacist may have to compound special preparations, such as skin creams or ointments, or mix liquid antibiotics. Pharmacists educate patients about the correct use of medications and how to deal with possible side effects. Upon identifying any actual or potential medication-related problems, a pharmacist will contact the physician to make recommendations and find an appropriate solution. Physicians have a limited amount of time in which to assess a patient by listening to the patient’s problems, performing a history and physical examination, making a tentative diagnosis, ordering laboratory tests, deciding on appropriate treatment, and educating the patient about the treatment plan. They really don’t have time to adequately perform the additional tasks performed by a pharmacist, who have trained for at least 6 years to understand the nuances of medications. An employer-based clinic has a limited choice of mostly generic medications available for dispensing and no controlled substances. This often requires a patient to go to a local pharmacy for some, if not all, of his or her prescriptions. Local pharmacies are often less expensive because of bulk purchasing and special pricing. There are hundreds of medication-related problems and errors prevented by pharmacists every day, saving enormous costs by avoiding hospital and emergency room visits, serious side effects, and even deaths. Please vote no on SB 397 to keep patients at employer-based clinics safe from the many potential dangers of medications.
Please use the following links to contact Missoula's representatives on the House Committee.
Michele Reinhart HD97 MICHELEREINHART@GMAIL.COM
Dave McAlpin HD94 MCDAVE94@HOTMAIL.COM
Diane Sands HD95 HDSANDS@AOL.COM
Just let your representative know your vote: that you oppose the bill and to "TABLE SB397" thats all that's needed! Becky, Jim, and Starla need our support. Thank you!
For more information pertaining to these bills visit: Montana State Legislation for Bill information, and GrizRPh Current Legislation for a break down of what is happening in Helena with SB397 and more!
Wednesday, March 21, 2007
Time Sensitive Material...please read now!
Dear Pharmacies,
There are important matters at the level of the House Human Services committee that need our attention. SB397 is a bill that has sailed through the Senate with a unanimous vote of 50 to 0 and is at our back door. SB397 will give practitioners the ability to dispense medications to the public, just as pharmacies do, without a pharmacist on staff. There are some parts of the legislation that needs definitions as well as some expounding on who will actually dispense the drugs and who will counsel on the medications. One thing is clear... they don't want to pay a pharmacist to dispense or counsel medications in an "employer based onsite clinic"... and the question is how loosely this definition will be used. We all know where this is heading... huge patient safety concerns! If you work at a retail pharmacy, as I do, you know how devastating this can be. Physicians play a critical role in our community and I applaud their knowledge and prescribing practices; however, I believe that pharmacists also play a critical role in the healthcare system as well as the check-n-balances of that system…which should remain the same for the sake of our patients!
If every pharmacist receiving this could forward the message to all pharmacists they know, asking them to contact their area legislators on the House Human Services committee regarding SB397, asking those legislators to vote to table the bill or suggest "do not pass" that would be very helpful. You can use some of Becky Deschamps attached comments if you would like. Starla Blank has given a list of some of the pharmacists in home towns of legislators on the Human Services Committee, and Becky Deschamps has been calling those pharmacists yesterday and today to get the word out. We need to do this quickly, as SB397 won't sit in committee forever. The list can be found on Becky Deschamps' blog entitled "Current Legislation". Please act now... OR... at least please read through SB397 at Montana State Legislation and Becky Deschamps' blog.
Thanks for your support, please read the "About GrizRPh" statement for a better understanding of our mission. Also, please sign up for the RPh Messenger Service so you may get current upto date news from various highly respected pharmacists practicing in Montana.
Thank you,
Sincerely,
Eric Shields, PharmD
There are important matters at the level of the House Human Services committee that need our attention. SB397 is a bill that has sailed through the Senate with a unanimous vote of 50 to 0 and is at our back door. SB397 will give practitioners the ability to dispense medications to the public, just as pharmacies do, without a pharmacist on staff. There are some parts of the legislation that needs definitions as well as some expounding on who will actually dispense the drugs and who will counsel on the medications. One thing is clear... they don't want to pay a pharmacist to dispense or counsel medications in an "employer based onsite clinic"... and the question is how loosely this definition will be used. We all know where this is heading... huge patient safety concerns! If you work at a retail pharmacy, as I do, you know how devastating this can be. Physicians play a critical role in our community and I applaud their knowledge and prescribing practices; however, I believe that pharmacists also play a critical role in the healthcare system as well as the check-n-balances of that system…which should remain the same for the sake of our patients!
If every pharmacist receiving this could forward the message to all pharmacists they know, asking them to contact their area legislators on the House Human Services committee regarding SB397, asking those legislators to vote to table the bill or suggest "do not pass" that would be very helpful. You can use some of Becky Deschamps attached comments if you would like. Starla Blank has given a list of some of the pharmacists in home towns of legislators on the Human Services Committee, and Becky Deschamps has been calling those pharmacists yesterday and today to get the word out. We need to do this quickly, as SB397 won't sit in committee forever. The list can be found on Becky Deschamps' blog entitled "Current Legislation". Please act now... OR... at least please read through SB397 at Montana State Legislation and Becky Deschamps' blog.
Thanks for your support, please read the "About GrizRPh" statement for a better understanding of our mission. Also, please sign up for the RPh Messenger Service so you may get current upto date news from various highly respected pharmacists practicing in Montana.
Thank you,
Sincerely,
Eric Shields, PharmD
Friday, March 16, 2007
Attention Pharmacists, Technicians, & Professionals
This website is designed as a knowlege base to bring you updated information on pharmacy practice as well as keep community ties with our collegues. In addition, this website will have a focus on the "legislative branch of pharmacy" so that pharmacists voices may be heard louder from our community to protect our pharmacy practice. Thank you for visiting. Don't forget to sign up for the RPh messenger so that I may e-mail you for important topics, and date sensitive materials such as CE's and Legislative material! Please see Becky Deschamps "Current Pharmacy Legislation" (very important we act now...please see blog).
Eric
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Eric
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