By Douglas Hoey
Some weeks ago, NCPA started hearing from community pharmacists encountering problems with prescriptions for compounded Tamiflu suspension to help young children suffering from the H1N1 flu. The two major issues seemed to be shortages in supply (Tamiflu capsules, cherry syrup, OraSweet SF, etc.) and difficulty adjudicating claims with pharmacy benefit managers (PBMs).
We surveyed our members to further determine the scope of these problems. The response was strong and compelling. Eighty busy community pharmacists made the time to respond during the 48-hour comment period.
The supply problems are well-documented and the manufacturers of these products are working to address shortages. The billing concerns, however, were less well-known by the general public. To try to get these resolved, NCPA Executive Vice President and CEO Bruce T. Roberts, RPh, wrote to CVS Caremark, Express Scripts, Inc., and Medco Health Solutions, Inc., the three PBMs most commonly cited in the survey.
Bruce’s letter summarized the experiences reported by community pharmacists, cited the steps the federal government and others are taking during this national health emergency, and encouraged the PBMs to take similar action. Specifically, NCPA suggested “temporarily revising policies on billing Tamiflu compounds to expedite the process, making sure patients are receiving their urgently needed medication as quickly as possible and reimbursing pharmacists for their time and expertise.”
To their credit, the PBMs responded quickly though, as the saying goes, the proof is in the pudding. We have heard some encouraging reports from the field since we received their responses about newly available override codes and less severe prior authorization measures, but the jury is still out. Has your community pharmacy noticed any positive changes from PBMs in the last few days? Or is it more of the same? Post a comment on this site or send us an email here.