Sept. 22, 2009

Texas Pharmacy Business Council is an organization of American Pharmacies and the Academy of Independent Pharmacists-Texas.
www.TxRxCouncil.org

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Legislation success list

Community pharmacy scores well in Baucus bill

Efforts continue on FSA card issues

FTC paying attention to CVS Caremark complaints

HHS urged to modify HIT regulations

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	Texas legislation success list
REGULATION OF Rx DISCOUNT CARDS PBM TRANSPARENCY IN STATE CONTRACTS MAIL ORDER PARITY

Community pharmacy scores well in Baucus health care reform bill

If there has been any discussion in the news media about pharmacy, it's been limited to PhRMA. The pharmacist, especially independent pharmacists, has not garnered coverage, as far as I can tell. But that's OK, because the National Community Pharmacists Association has been busy behind the scenes and has scored some points for our team.

NCPA staff met last week with staff at the Health and Human Services Office of Health Reform to lay out key priorities for the health care reform bill. The Administration will obviously have a "seat at the table" when developing a final bill so NCPA continues to meet with HHS and White House staff to relay key priorities, according to NCPA Senior Vice President, Government Affairs John Coster, PhD, RPh.

This is a significant accomplishment for community pharmacy. Coupled with our recent approval of the Texas Medicaid fee increase, it demonstrates what pharmacists can accomplish when they get active and make their voice heard by public policy makers. This legislative process is far from over and we must remain vigilant to keep the items important to pharmacy in the final bill.

For community pharmacy, the health care reform bill presented last week by Sen. Max Baucus (D-MT.), chairman of the Senate Finance Committee, is a better bill than the House version discussed during Congress' August recess.

Medicaid reimbursement, AMP and AWP
Under the proposed Baucus bill, AMP would more closely reflect prices paid by retail pharmacies, and the FUL for generics would be set at no less than 175 percent of the weighted average AMP for the product. This is in contrast to the language in the House bill, which sets the FUL at 130 percent of the weighted average AMP.

NCPA met last week with the senior counselor staff of the Secretary of the Department of Health and Human Services to discuss both AMP- and AWP-related issues. NCPA explained our concerns with the AMP regulation proposed by the agency in 2007 (and now under injunction) to set FULs based on lowest AMP; we asked the agency to direct states to adjust their Medicaid brand name drug reimbursements to reflect the upcoming First Data Bank AWP settlement; and we asked them to approve state plan amendments for those states that choose to keep "pharmacies whole" as a result of the FDB settlement.

To date, Texas, is the only SPA that has been approved!

The AMP Coalition, of which NCPA is a member, sent a letter to the Bipartisan Congressional Leadership urging them to take immediate action to prevent CMS from implementing these cuts once the moratorium expires Sept. 30, 2009. However, we have no indication that CMS is developing another AMP regulation. We believe that they are waiting for Congress to act on AMP changes before issuing a new regulation.

DME accreditation exemption and deadline extension
NCPA meets today with CMS acting administrator Charlene Frizzera in an effort to get a deadline extension either through Congressional action or through action by CMS.

NCPA continues work with the offices of Reps. Space (D-OH), Berry (D-AR), Moran (R-KS) and Emerson (R-MO) to push through legislation that would extend the accreditation and surety deadline from Oct. 1, 2009 for three months until Jan. 1, 2010. The intent is to extend the time until health care reform legislation can be passed. Senators Grassley (R-IA) and Tester (D-MT) also are helping with this issue.

In addition to the House health reform bill action, which exempts pharmacies from DMEPOS accreditation if they only sell crutches, canes and diabetes supplies, the Baucus bill includes an accreditation exemption for small pharmacies. Pharmacies whose Medicare DMEPOS billings are less than 5 percent of their total pharmacy sales would be exempt.

The Baucus bill also includes:

a PhRMA discount program for brand name drugs covered in the Part D "donut hole,"
a state-based system of "co-ops" to provide a health insurance option to individuals who do want or are unable to obtain coverage from the private insurance marketplace, and
multiple opportunities for pharmacies to provide patient care services as part of a reformed health care system, such as through accountable care organizations. Pay attention to these opportunities. They reflect the pharmacist's role in the health care continuum and offer additional enterprise-building activities.

PBM transparency
NCPA is working with Senator Maria Cantwell (D-WA) to attach PBM transparency language through an amendment to the Baucus bill. The transparency language is similar to that included in the House Energy and Commerce health care reform bill and reflects language proposed by NCPA.

Stay tuned!

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

Efforts continue on FSA card issues

Many of our members are calling about problems they're having trying to process FSA cards under the '90 percent exception" rule. The challenge is that third party administrators and plan sponsors do not have to process the cards, that their recognition of the '90 percent exception" rule is "optional!"

NCPA senior staff met for almost two hours Friday with representatives of the U.S. Treasury Department and IRS discussing the FSA cards and asking them to consider revising their position and make it clear to TPAs and plan sponsors that pharmacies certified under the 90 percent option are able to process these cards like those pharmacies that use IIAS systems. There should be no discrimination against independent pharmacies.

While not committing, they appeared to be open to looking at options that might enhance pharmacy participation with these FSA cards. The Treasury and IRS staff told NCPA they believe plans may not be allowing FSA transactions under the 90 percent option because pharmacies are unable to substantiate those transactions at the POS, and the plan's insistence to collect the more burdensome paper verification from the enrollees using cards.

NCPA is considering various options to enable independent pharmacies to serve their patients who have FSA cards. But they're not stopping with the staff discussion, they're also considering a Congressional approach to this issue.

FTC paying attention to CVS/Caremark complaints

The information you are submitting about CVS Caremark anti-competitive and anti-consumer practices is beginning to make an impression on the Federal Trade Commission.

NCPA senior staff and outside counsel met this past week with the FTC legal team that is reviewing the CVS Caremark merger. They presented the mounting evidence regarding the merged company's egregious practices.

They urged pharmacists continue collecting evidence of these types of practices that might be occurring. Please e-mail or fax to Texas Pharmacy Business Council at 512-992-1391. We can use this information in our ongoing efforts on the state level, and we'll forward to the appropriate people at NCPA.

Stories from your patients' perspective are particularly compelling. Please visit with your patients who are having or have had problems with CVS Caremark and ask if they would tell their story. Offer to help them tell the story, perhaps while they are in your pharmacy, and you can help them with writing it up on a computer and send to TPBC.

We are optimistic and so is NCPA that the FTC is looking closely at this merger and the evidence that we are presenting to them.

HHS urged to modify HIT regulations

The National Community Pharmacists Association is asking the Health and Human Services Office for Civil Rights to modify regulations of the HITECH Act privacy provisions' affects on community pharmacists' business practices.

They sent a letter offering suggestions to ensure approximately 23,000 community pharmacies across America are not crippled by time-consuming and expensive bureaucratic hurdles in order to be in compliance with the HITECH Act. Without these suggested modifications millions of community pharmacy patients, especially in underserved rural and urban communities, could see their access to prescription drug services limited.

Issues addressed in the letter include:

Accounting of disclosures
Patient requested restrictions on disclosures
Business associates and updated agreements
Prohibition on payment for exchange of data
New enforcement provisions

The entire letter is available for download.

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