Medicare is imposing a year-long delay of its “short-cycle” dispensing rule for long-term care facilities. The rule will take effect January 1, 2013, instead of January 1, 2012. The final rule also made several other key adjustments including:
•it allows LTC pharmacies to dispense solid oral doses of brand-name medications in 14-day-or-less supplies, compared to the more onerous 7-day-or-less mandate;
•it eases the requirements on how LTC pharmacies account for dispensed, but unused medications.
CMS is delaying the originally scheduled start date for round two of its competitive bidding program for Medicare Part B-covered durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) for six months, until the summer of 2013. The national mail order round for diabetes testing supplies also is postponed. CMS’s competitive bidding program has already gone into effect in Cincinnati and Cleveland. In round two, the program is set to be implemented in 91 areas nationwide as is the diabetes testing supplies mail order program.
The readers of Consumer Reports magazine gave independent community pharmacies the highest satisfaction rates among pharmacy providers and found independents to be competitive on pricing as well, according to the publication’s 2011 pharmacy survey. Ninety-four percent of the readers responding to the survey said they were highly satisfied with their experiences at independent pharmacies, based on categories including personal service, knowledge and speed in filling prescriptions. In addition, the magazine found that independent pharmacies offered lower prices on popular brand-name drug prices than traditional, national pharmacy chains.
H.R. 1041: Fairness in Medicare Bidding Act, sponsored by Reps. Glenn Thompson (R-Pa.) and Jason Altmire (D-Pa.), would totally repeal the competitive bidding program in a budget neutral manner. Currently 83 representatives have joined as co-sponsors. In Ohio this includes Reps. Mike Turner, Pat Tiberi, Betty Sutton, Steve Stivers, Tim Ryan, Jim Renacci, Steve LaTourette, Bob Gibbs, and Steve Austria. If your Congressperson is not on this list, please call him/her about signing on.
H.R. 891/S. 274: Medication Therapy Management Empowerment Act. These two companion bills seek to accomplish three things.
•To improve access for seniors to MTM benefits by lowering the eligibility criteria. In this bill, a senior suffering from any chronic disease that accounts for high spending in the Medicare program would be eligible for MTM services. This legislation also opens up the MTM program to first time dual-eligibles and individuals in transitions of care.
•To improve patient choice by allowing Medicare beneficiaries to use the pharmacy of their choice so long as the pharmacy has agreed to participate.
•The bills also address payment and quality by ensuring that drug plans reimburse pharmacies and other qualified MTM providers based on the time and resources necessary to provide MTM care.
The bill, sponsored by Rep. Bruce Goodwin, would eliminate most of the restrictions in current law governing certain APNs’ ability to prescribe schedule II controlled substances. The practical effect of these changes is that the bill authorizes an APN with prescriptive authority to prescribe a schedule II controlled substance in any circumstance as long as the APN is doing both of the following:
(1) acting in the course of professional practice;
(2) acting in collaboration with a physician or podiatrist and in accordance with other applicable laws. To practice collaboratively, the APN must have entered into a “standard care arrangement” with the collaborating physician or podiatrist. An APN’s prescriptive authority may not exceed the prescriptive authority of the APN’s collaborating physician or podiatrist.
The most significant thing facing pharmacy in the budget is the carve-in of pharmacy back into the managed care system. OPA has voiced its serious concern about being carved back into the managed care system. In the past providers, including pharmacists, have had real issues with access and administrative problems with the Medicaid managed care entities. Some of their business decisions have jeopardized provider willingness and ability to participate in Medicaid and the availability of care for Medicaid beneficiaries. In the past, providers have felt disadvantaged in the contracting process with Medicaid managed care entities regarding proper fees, timely payments for services, and random termination of participation contracts. Our pharmacies are prohibited by federal antitrust law from jointly negotiating with the managed care organizations, thus limiting our ability to receive a fair reimbursement and dispensing fee under many of these contracts. The individual pharmacist is simply told to take the reimbursement or leave the managed care network. We would like to see ODJFS implement statutory and/or administrative changes to address these concerns.
If you have any questions or comments about the issues mentioned in this article, please contact Kelly Vyzral, Director of Government Affairs, at 614.586.1497 or kvyzral@ohiopharmacists.org.