Tuesday, December 4, 2007

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

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

"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.

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.

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.

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.

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