Patients believe that access to their prescription medications for government
health care programs should not be compromised by unfair reimbursement
practices and policies to their community pharmacy providers, according to
a new survey from the polling company(TM), inc.
“Our patients have it right: they know community pharmacies play a
critical role in their health care,” said Stephen Giroux, PD, NCPA
president and owner of five pharmacies in Western New York. “They want us
there to address their health care needs. Now Congress needs to heed their
request and pass specific Medicare and Medicaid reimbursement fixes before
more local pharmacies are forced out of these government programs, or have
to close their doors.”
The Coalition for Community Pharmacy Action–comprised of the National
Community Pharmacists Association (NCPA) and National Association of Chain
Drug Stores (NACDS)–commissioned the polling company(TM), inc., to conduct
a comprehensive survey of 1,000 pharmacy patients nationwide from November
26 – December 2, with a margin of error of (+/-) 3. From a legislative
perspective, the level of patient support for fixing the current slow
reimbursement of Medicare Part D prescription drugs by the pharmacy benefit
managers (PBMs) that administer the plans, and the forthcoming cuts in the
reimbursement of Medicaid generic prescription drugs was resounding.
The survey found 83 percent of respondents said it was unfair that
“PBMs and prescription drug plans keep money as long as possible, allowing
them to earn interest on it, while pharmacies must continue to provide
their services and prescription drugs upfront to patients even though they
haven’t been paid.” The survey also found 83 percent support “new
legislation in Congress to ensure pharmacies providing Medicare Part D
patients are reimbursed by the government within 14 days.”
Slow pharmacy reimbursement of Medicare Part D prescription drug claims
by PBMs cause cash flow problems for community pharmacies that force them
to take out loans in the tens to hundreds of thousands of dollars range.
The bills – H.R.1474, the Fair and Speedy Treatment of Medicare
Prescription Drug Act of 2007, and S.1954, the Pharmacy Access Improvement
Act (PhAIM) of 2007?require complete and accurate Part D claims submitted
electronically be paid within 14 days by electronic funds transfer, and
paper claims within 30 days.
In addition, the survey found 78 percent thought it was unfair that
“under the new rule, pharmacies that participate in the Medicaid program
would have to sell generic drugs at a loss.” The survey also found 78 were
less likely to support the new rule because “many community pharmacies will
not be able to continue servicing Medicaid patients, including children,”
especially after they learn “over 28 million children in the U.S. get
prescription medications paid for by the Medicaid and account for over half
of the beneficiaries.” Furthermore, the survey found 74 percent support
legislation that would reimburse pharmacy more fairly.
The Centers for Medicare & Medicaid Services’ (CMS) Medicaid generic
prescription drug pharmacy reimbursement formula is based on a flawed
Average Manufacturer Price (AMP). According to a Government Accountability
Office study, on average community pharmacies will be reimbursed at least
36 percent below their acquisition costs when the change is fully
implemented in early 2008. While the legislative solutions are slightly
different in the House and Senate, the goal of limiting the damage AMP
would have on community pharmacies is the same. H.R.3140, the Saving Our
Community Pharmacies Act, establishes a new and fair pharmacy reimbursement
benchmark reflective of what the actual retail costs are and includes
provisions to drive generic drug utilization that increase taxpayer
savings. While S.1951, the Fair Medicaid Drug Payment Act of 2007, is
focused on improving the AMP formula criteria for determining the averages
and raises the maximum amount of potential reimbursement.
“We have reached critical mass in our efforts to rectify the
debilitating consequences of the Medicare Part D and Medicaid reimbursement
systems,” said Bruce Roberts, RPh, NCPA executive vice president and CEO.
“The sentiments expressed by community pharmacies, members of Congress, and
organizations such as NCPA and the National Rural Health Association are
well known. The missing voice has been the patients who are adversely
affected by the consequence of community pharmacies being squeezed to the
breaking point. Now we have a comprehensive scientific survey indicating
patients find the reimbursement policies objectionable and are supportive
of the pending legislative solutions that should spur action in the halls
of Congress.”
The National Community Pharmacists Association, founded in 1898,
represents the nation’s community pharmacists, including the owners of more
than 23,000 pharmacies. The nation’s independent pharmacies, independent
pharmacy franchises, and independent chains dispense nearly half of the
nation’s retail prescription medicines. To learn more go to
http://www.ncpanet.org.
SOURCE National Community Pharmacists Association