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March 16, 2010

Texas Pharmacy Business Council is an organization of American Pharmacies and the Academy of Independent Pharmacists-Texas.
In this issue


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TDI pharmacy help
The Texas Department of Insurance has a Pharmacist Resource Page that includes links to complaint forms and advises when the next Pharmacy Outreach Conference Call will be held.

Add this link to your online "favorites" list
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Texas legislation  success list
 
Regulation of Rx discount cards


 PBM transparency in state contracts

Mail order parity

becks All eyes on Washington, D.C. this week
NCPA committee forum, PAC telethon & health care reform legislation
This week will be one of the most, if not THE most eventful weeks in this country's history. All eyes are on Washington, D.C. where a vote is expected on final passage health care reform legislation. And I'm heading into the middle of it for the National Community Pharmacists Association annual committee forum.

This is the meeting at which a small group of members representing your interests determine what we want NCPA to try to accomplish this year for independent pharmacy. The NCPA steering committees cover communications, compounding, home health, long-term care, innovation/technology, management, multiple locations, national legislation and government affairs, patient care and third party issues. I'm participating as chair of the National Legislation Committee. All of this is, in part, preparation for the National Legislation and Government Affairs Conference May 10-12 in Washington, D.C.

Prior to our meeting, we will be participating in a telethon to raise money for the NCPA political action committee. Thanks to you, in just five years this PAC has risen from 963rd to the 40th largest association PAC in the country. This means you and your fellow independent community pharmacists perceive the problems you are facing as serious enough to warrant your financial input. We can't stop now. With so much at risk, when have we had more need to keep our supporters in office?

Also this week, House Speaker Nancy Pelosi hopes to nail down the 216 votes from House Democrats needed for passage of a health reform bill. The plan is for the House to take up the Senate's health care reform bill that passed Christmas Eve which, on balance, is better for community pharmacy both on health care and business related issues as compared to the House bill that passed last November. The Senate and House would then make changes to the Senate bill through the now-famous reconciliation process.

With respect to community pharmacy, the health care reform bill, if enacted into law, would:
  • Reform the Medicaid pharmacy reimbursement system by assuring that only sales to community retail pharmacies would be included in the definition of average manufacturers price (AMP). It  also would set reimbursement for federal upper limits (FULs) for generics at 175 percent of the weighted average AMP; 
  • Provide for an exemption from DME accreditation for certain pharmacies whose Medicare DMEPOS billings are 5 percent or less of total pharmacy sales;
  • Require transparency for PBMs under contracts to plan in the health insurance exchanges;
  • Expand Medicaid coverage to individuals up to 133 percent of the federal poverty level;
  • Create a grant program for pharmacies to help test new innovative methods to provide medication therapy management;
  • Close the Medicare Part D donut hole over a number of years through new federal funds as well as discounts from pharmaceutical manufacturers;
  • Require Part D plans to use specific dispensing techniques to reduce pharmaceutical waste in long-term care facilities.
Stay tuned!

Richard's signature
Richard E. Beck, RPh
Executive Director, Texas Pharmacy Business Council

Federal employees forced to use CVS stores
Once again, CVS/Caremark is providing fodder for the Federal Trade Commission's investigation into the pharmacy/PBM merger. One of our member pharmacies reports a patient of his, who can only get a 90-day prescription supply by mail order, is now being told he can get the same lower rate at a CVS store. And when the federal employee tried to refill a prescription at the independent community pharmacy, Caremark rejected the claim because a maximum number of refills via a local pharmacy has been exceeded and the patient must use mail order.

Forcing federal employees into this arrangement would be prohibited by HR 4489, the bill I testified about last month on behalf of the National Community Pharmacists Association. The bill ensures program integrity, transparency and cost savings in the pricing and contracting of prescription drug benefits under the Federal Employees Health Benefits Program.

We have shared this information with bill sponsor Stephen Lynch (D-MA). We need information on other incidents like this. If you have experienced this, please send us detailed information:
  • Which federal agency your patient works for.
  • Whether the patient will permit his or her name to be used.
  • If possible, a short signed story from the patient about his or her experience.
This  information will be very helpful for passing HR 4489.
Senator probes pharmaceutical industry via PBMs & PCMA
The PBM-pharmaceutical industry partnership is a target of U.S. Senator Chuck Grassley (R-IA), the ranking Republican on the Senate Finance Committee. He sent the two largest PBMs and the Pharmaceutical Care Management Association letters last week asking them to provide information about their financial relationships with drugmakers. This week, he sent letters to Express Scripts, CVS Caremark and the Pharmaceutical Care Management Association.

Senator Grassley's letter notes that a report last year by the Medicare Payment Advisory Commission (MedPAC) recommended that Congress should require drugmakers to report their financial relationships with pharmacy benefit managers, pharmacies, health plans and others, but not rebates or discounts.

And so he asks for details about steps taken that would enhance transparency of "financial benefits" that may be provided by drugmakers. This includes MedPAC's proposal that payments or transfers of value, such as gifts, travel, honoraria, consulting fees and investment or ownership interests should be revealed, excluding reporting of rebates and discounts. Senator Grassley likened the requirement to the stipulations found in the Physician Payments Sunshine Act, which he and Senator Herb Kohl (D-WI) introduced that requires drug and device makers disclose anything of value given to doctors and post the info on Web sites.
Texas Pharmacy Business Council
Ensuring patient access to quality pharmacy care services,
the viability of community pharmacy and the pharmacy profession.

1001 Congress Ave., Suite 250, Austin, TX 78701 512.992.1219
Richard E. Beck, RPh, Executive Director
www.TxRxCouncil.org
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