More Changes Possible to Senate Health Reform Bill


By Kevin Schweers

Recent health reform activity in the U.S. Senate could have new implications for community pharmacy.  Three new amendments, in particular, have been offered and were endorsed today by NCPA.

Perhaps most notably, Sen. Sherrod Brown (D-OH) wants to exempt community pharmacies from DMEPOS surety bond requirements.  The other amendments, respectively, would advance medication therapy management in Medicare and produce the first federal cost of dispensing study for Medicaid in more than a decade.

In addition, Senators are reportedly contemplating asking the U.S. Office of Personnel Management (OPM) to administer health coverage in the so-called public option.  OPM currently oversees the Federal Employees Health Benefits Program and relies primarily on CVS Caremark to administer the drug benefit. 

That contract arrangement has been the subject of pointed questions from OPM’s own inspector general and U.S. Rep. Stephen Lynch (D-MA), Chairman of the House Oversight and Government Reform’s Subcommittee on the federal workforce, the U.S. Postal Service and the District of Columbia.  NCPA’s Bruce Roberts recently wrote about this Federal Times.

NCPA officials are urging Congress to ensure that the drug benefit of any such program is administered by a pharmacy benefit administrator, rather than a PBM, and to retain PBM transparency language in the legislation.

More details can be found in today’s NCPA statement pasted below and also available here.

NEWS RELEASE

NCPA Backs New Amendments to Senate Health Reform Bill;

Expresses Concern over Revised Public Option’s Pharmacy Benefit

 

Alexandria, Va. (Dec. 8, 2009) – The National Community Pharmacists Association (NCPA) today endorsed three amendments recently proposed to the Patient Protection and Affordable Care Act and raised questions about an emerging public insurance option that would be administered by the federal Office of Personnel Management (OPM). NCPA Executive Vice President and CEO Bruce T. Roberts, RPh, issued the following statement:

“NCPA strongly supports an amendment by Sen. Sherrod Brown (D-OH) that allows pharmacies to continue providing Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Part B drugs to Medicare beneficiaries without purchasing a surety bond. Like the 14 other types of medical professionals that Medicare exempted from the surety bond requirement, pharmacists are licensed and regulated by the states. Requiring surety bonds is duplicative and may lead to loss of patient access to valuable health care services, such as diabetes testing supplies, canes and crutches.

“We continue to work with Congress on both a permanent pharmacy exemption from DMEPOS accreditation requirements, as well as an extension of the current moratorium, which is scheduled to expire on Dec. 31, 2009.

“Sen. Kay Hagan (D-NC) added important language to the Senate ‘Freshmen Value and Innovation Package’ amendment to codify Medicare’s medication therapy management (MTM) program. MTM utilizes community pharmacists to help patients adhere to, and maximize the benefits of, their medicine. The programs have been shown to improve outcomes while lowering health care costs.

An amendment by Sen. Michael Bennet (D-CO) would require the Government Accountability Office (GAO) to conduct the first detailed study in more than 10 years of pharmacists’ cost of dispensing in the Medicaid program. Private studies have shown community pharmacists to be compensated well below their cost of dispensing and a GAO study could give Congress and the states needed information for measuring the adequacy of the dispensing fees they pay and the impact upon patient access to pharmacy services.

“Various news reports indicate Senators are considering an OPM-administered health plan for the uninsured.  Under such a model, we urge lawmakers to utilize a pharmacy benefit administrator (PBA) to manage drug coverage, rather than a pharmacy benefit manager (PBM).

“PBMs have a history of inflating health care costs through bloated administrative fees and questionable practices that are hidden from patients and plan sponsors. OPM’s inspector general told a House subcommittee investigating the PBMs’ effect on the federal employee health plan that ‘there’s a good chance we’re not getting a good deal because of the lack of transparency.’

“A PBA, such as those employed by Medicaid and the Pentagon, would give patients and taxpayers the best bang for their buck by passing through all rebates, discounts, and price concessions. PBM transparency requirements in the current bill should continue to apply to any plan that operates within the exchange, including the public option.

“NCPA is grateful for Congress’ bipartisan support of community pharmacy in health care reform and we will continue to work with lawmakers as the legislative process continues.”

###

The National Community Pharmacists Association (NCPA®) represents America’s community pharmacists, including the owners of more than 22,700 independent community pharmacies, pharmacy franchises, and chains. Together they represent an $88 billion health-care marketplace, employ over 65,000 pharmacists, and dispense over 40% of all retail prescriptions. To learn more go to www.ncpanet.org or read NCPA’s blog, The Dose, at https://ncpanet.wordpress.com.

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