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
Thursday, April 19, 2007
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
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