What the Latest Senate Health Care Reform Proposal Means for Community Pharmacy

We’re still reviewing the 2,000+ page health reform proposal released by Senate Democratic leaders Wednesday night, but here’s what our initial read shows:

Senate Finance Committee’s AMP Fix Retained – Under current law (temporarily blocked by court injunction), Medicaid would base its reimbursement of community pharmacies for generic drugs on the Average Manufacture Price (AMP). The Government Accountability Office estimated this would reimburse pharmacies more than 36% below the costs of acquiring the medications. This latest proposal maintains provisions from the Senate Finance Committee that would set Medicaid pharmacy reimbursements at “no less than 175% of the weighted average AMP.” That still may not be enough for independents and we’re continuing to work with Congress on it, but it is significantly better than the House’s proposed reimbursement formula.

PBM transparency included – Senate Democratic leaders have included provisions backed by 30+ consumer, labor and Medicare beneficiary advocate organizations and retained transparency requirements for pharmacy benefit managers (PBMs) participating in the proposed health insurance exchange. This broad coalition supports PBM transparency as a common-sense way to help ensure patients and health plan sponsors get a good deal in their drug benefit.

Qualified exemption from Medicare’s durable medical equipment (DME) accreditation requirements – Currently, burdensome accreditation requirements, delayed until Jan. 1, 2010, would prevent thousands of independent community pharmacies from continuing to continue participating in the DME program and provide their patients with needed health care items such as diabetes testing supplies. The Senate bill would further delay any accreditation requirement to Jan. 1, 2011 and instructs the Secretary of Health and Human Services to implement any future accreditation requirement in a way that’s much more palatable for community pharmacies.

Including Pharmacists in Medical Home Concept – The Senate bill includes pharmacist participation in integrated care models and a Medical Home Pilot program. Community pharmacists are accessible to patients and provide medication therapy management and continuity of care – essential components of the Medical Home Concept.

NCPA’s government affairs team will soon conclude its analysis of the Senate proposal and will continue to actively work with Members of Congress from both parties to advance the priorities of independent community pharmacists.

1 Response to “What the Latest Senate Health Care Reform Proposal Means for Community Pharmacy”

  1. 1 thepharmacyidealist November 21, 2009 at 4:17 pm

    These are definitely some needed fixes to pharmacy operations. However, I do not believe this HCR bill is going to change pharmacy practice or advance it particularly far. I am not sure if they even restrict the MTM role to pharmacists. Also, there are a few very stellar pharmacists/organizations that are taking advantage of current MTM provisions, but on a whole it really hasn’t caught on as much as I had hoped.

    I believe we are a very cost effective option to be disease managers, so I wish pharmacists in primary care roles were addressed.


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