To say that the Medicare prescription drug (Part D) benefit hasn’t exactly been a walk in the park for community pharmacists would be putting it mildly. During its rather chaotic implementation four years ago this month, local pharmacists spent countless hours online and on hold, trying to resolve coverage problems for their patients. Often they were “rewarded” with long waits for reimbursement from plan administrators, typically pharmacy benefit managers (PBMs).
Archive for January, 2010
Here’s a final on-the-ground account from William C. Drake, PharmD and NCPA member, of his past several days concluding a volunteer tour in Haiti as one of the Chief Pharmacists for a U.S. Department of Health and Human Services’ Disaster Response Team.
Tags: pharmacist, pharmacy benefit managers
By Douglas Hoey, RPh, MBA
Ask a community pharmacist for a list of professional pet peeves and odds are good that pharmacy benefit manager (PBM) audits will rank near the top. In this process, PBMs pore over a pharmacy’s books and look for any excuse to take money back from the pharmacy. What’s done with that recouped money and how much is shared with health plan sponsors is anybody’s guess. Turnabout is not fair play as PBMs consistently resist similar oversight from their clients. A new PBM legal settlement brings this issue into focus. Continue reading ‘Another Year, Another PBM Legal Settlement’
Tags: average manufacturer price, durable medical equipment, Health Care Reform, medication therapy management, pharmacist, pharmacy benefit managers
By John Coster, RPh., Ph.D.
The upset Republican win in Tuesday’s Senate race in Massachusetts calls into question the future of the health care reform legislation that consumed so much congressional effort in 2009 and into the new year. Along with it, the outlook becomes unclear for several community pharmacy priorities, despite the support of a growing consensus in Congress. Continue reading ‘A Massachusetts Monkey Wrench in Health Care Reform?’
Tags: adherence, medication therapy management, NCPA Convention, pharmacist
Resolutions for 2010 are top of mind now and living healthier is one of the most common. So it seems timely to revisit a “2 a day” approach to boosting medication adherence that was first outlined at NCPA’s most recent convention during a speech by Executive Vice President and CEO Bruce T. Roberts, RPh. Here are some excerpts: Continue reading ‘Small Steps toward Greater Medication Adherence’
Tags: average manufacturer price, average wholesale price, Health Care Reform, Medicaid, pharmacist
On Capitol Hill it’s crunch time for health care reform as negotiations between House and Senate leaders pick up speed. A top priority for community pharmacies is getting an adequate fix to Medicaid’s reimbursement formula for generic drugs. So we held a briefing today to update reporters on where things stand and to demonstrate the strong, bipartisan support there is in Congress for an equitable reimbursement formula. Here’s a quick recap; a recording of the call is available here. Continue reading ‘Getting that Medicaid AMP Fix Right in Health Reform’
Tags: Health Care Reform, pharmacist
By John Coster, R.Ph., Ph.D.
As a society, we’ve enacted programs like Medicaid and the State Children’s Health Insurance Program (SCHIP) to help the lowest-income and most dependent Americans, respectively, have access to health care.
But is it possible for a charity program to be too charitable, to its own detriment? Continue reading ‘Targeting 340B Prescription Drug Discounts to Those Most in Need’
Tags: CVS Caremark, Health Care Reform, pharmacist, pharmacy benefit managers
By Devin Stone
Demanding transparency from pharmacy benefit managers (PBMs) is a notion that has clearly gained steam. Most recently, the U.S. Senate and House have approved limited PBM disclosure requirements in their health reform bills. It’s a small step toward reining in egregious and costly PBM practices like spread pricing (paying the pharmacy one price then quietly billing health plans much more) and rebate abuse (pocketing huge sums from drug makers before giving plan sponsors what’s left). Leading patient and labor advocates agree. Continue reading ‘PBM Transparency and the CVS Caremark Conundrum’
By Douglas Hoey, R.Ph., MBA
Everyone’s feeling the pinch of rising health care costs and trying new strategies to grapple with them. To that end, Caterpillar, Inc. (CAT), makers of those familiar yellow bulldozers and other construction equipment, recently began implementing an exclusive deal with Walgreen’s and Wal-Mart to provide prescription drugs to employees, retirees and dependents.
Continue reading ‘Congressman Looks into Caterpillar’s Deal with Walgreen’s, Wal-Mart’