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Texas Pharmacy Business Council is an organization of American
Pharmacies and the Academy of Independent Pharmacists-Texas.
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Medicaid, Medicaid, & more Medicaid |
This interim between Texas legislative sessions has been
one of the busiest I have ever experienced in my 25 years of advocacy
work. If I had to give this session a title, it would be
"Medicaid, Medicaid, and More Medicaid"! Sure, we have a
couple of other issues, but the damage from proposed Medicaid cuts is
enormous.
Medicaid Managed Care
- We
have a consultant working with us on comments to HHSC regarding
the "carve in" of the Vendor Drug Program. The comment
period has been extended to Dec. 31.
- We
are preparing an in-depth position paper, working with NCPA's
staff economist, and using new Texas demographics.
- We
have an open records request to HHSC for copies of all
documents, correspondence, memoranda, notes, e-mails,
communications, reports, and written information that pertains
to, references, relates to, or arises out of the matter of the
proposal to "carve in the VDP" into managed care.
Medicaid fee cuts
- We
already experienced a 1 percent cut in dispensing fees due to
budget shortfalls in the current biennium. It went into effect
Sept. 1 by emergency rule, event though the final rule was
adopted Dec. 8.
- Another
1 percent fee cut is proposed to go into effect Feb. 1. The
fixed component of the dispensing fee would be reduced to $7.35
and the variable component would be 1.96 percent and there
would be no changes to the delivery and premium preferred
generic incentive amounts.
- We're
concerned whether the administrative procedures act is
being followed relating to these cuts, and we're following it
closely.
Workers' Compensation
- Fee
guidelines and a mandatory formulary are just two of the Texas
Department of Insurance's Workers' Compensation Division issues
we are following. TDI is up for Sunset
review, something left incomplete in the past legislature.
This legislature is facing some monumental tasks, not
the least of which is accommodating a $20 billion+ budget shortfall.
Redistricting is always a time-consuming and contentious issue. In
addition to regularly scheduled Sunset reviews for agencies such as
the Texas Commission on Environmental Quality, the legislature
left unfinished from the past session Sunset reviews of TDI
and the Texas Department of Transportation.
The work load is so heavy, many long-time observers are
predicting at least one special session. At the same time, with an
overwhelming single-party composition, agreements should be reached
faster than if a lot of compromises have to be hammered out.
In the meantime, the board and staff of the Texas
Pharmacy Business Council wish you a joyous Christmas and prosperous
New Year!
STAY TUNED!
Richard E. Beck, RPh
Executive Director
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Congress freezes TRICARE retail pharmacy co-pay
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In the last moments of this Congress, a provision in
the National Defense Authorization Act, passed Dec. 22 by both the
U.S. Senate and House of Representatives, freezes retail pharmacy
co-pays in the TRICARE program.
The vote directing the Department of Defense not to increase retail
pharmacy co-payments is a victory for TRICARE beneficiaries' choice
as to where they fill their prescriptions. For another year the
co-payment system will respect the choice of TRICARE patients who
prefer to obtain their pharmacy services from community pharmacies,
and prohibit the Department of Defense from creating incentives for
patients to use mail.
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Allow collective negotiation for pharmacies
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Federal Trade Commission and Dept. of Justice
healthcare guidelines issued in 1996 are past-due for revision,
according to long-time antitrust crusader David Balto. The former FTC
attorney testified Dec. 1 to the House Judiciary Committee, noting it
is the patient who ultimately will be harmed because pharmacies
cannot collaborate under current FTC Healthcare Guidlines.
Balto said the solution is an antitrust exemption and greater
flexibility under the FTC Healthcare Guidelines to permit pharmacies
to collectively negotiate, especially for Accountable Care
Organizations. He pointed out the Guidelines have been interpreted in
a fashion that puts the thumb on the scale in favor of insurers and
against providers.
"There should be clearer safe harbors especially when provider
groups are nonexclusive," Balto said. "In addition,
specific safe harbors should be provided for pharmacies seeking to
collaborate with ACOs."
A
summary of the testimony:
- The
central priority in antitrust enforcement should focus on health
insurance and PBMs. From both a competition and consumer
protection perspective health insurance and PBM markets are
severely dysfunctional. Few markets are as concentrated, opaque,
and a fertile ground for deceptive and anticompetitive
conduct. Preventing any increase in concentration or any
anticompetitive practices by insurers should be the central
priority of antitrust enforcers.
- Enforcement
priorities have been severely misallocated. There were no cases
against health insurers or PBMs in the past administration and
more than 30 against physicians for alleged collective
negotiating. Healthcare enforcement priorities need to be
realigned in the wake of the reform efforts and the new
challenges that will arise from reform. The past focus on
physician or pharmacy negotiations is simply misplaced.
Enforcement in these cases should focus on situations with
demonstrable competitive harm.
- The
FTC and DOJ healthcare guidelines, which were last issued in
1996, need to be revised to provide greater opportunities for
collaboration among providers including pharmacies. The agencies
must establish meaningful deadlines for issuing advice on
collaborations and stick to those deadlines.
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New Part D provisions reminder
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The first steps under health reform to reduce the
Medicare Part D donut hole begin this year. Patients in the 'hole'
will pay a discounted 50 percent on brand drugs and the insurer pays
the other 50 percent. This could possibly increase pharmacy
receivables while you wait on the plans to ante up their share.
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CMS errs on
Humana/Walmart Part D plan
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NCPA again has told the Centers for Medicare & Medicaid
Services that it should not have approved the new Humana Walmart Part
D plan. "This plan would appear to discriminate against patients
who need specialty medications, as well as those who do not live near
a Walmart pharmacy," NCPA wrote CMS Dec. 14. "For those two
reasons alone, beyond the complexity of the benefit design, we once
again reiterate our view that this plan should not have been
approved.
"Moreover, we urge CMS to apply the traditional higher standard
to pharmacy network access proposals for the 2012 plan year. We fear
that the gains made by Part D in improving medication use and
reducing other medical expenditures will be reversed if the
patient-pharmacist relationship is disrupted. We believe this will
occur if restrictive pharmacy networks as approved in the
Humana/Walmart plan become commonplace in Part D plans."
Click here for
the full letter.
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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
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