WASHINGTON Efforts by retail pharmacy advocates to turn aside a federal plan that forces pharmacies to bid for the right to sell durable medical equipment under the Medicare Part B reimbursement program reached a high point today, with chain pharmacy leader Jose Navarro urging a congressional panel to halt the implementation of the new rule.
Navarro is a board member of the National Association of Chain Drug Stores and former president of 20-store Navarro Discount Pharmacies in Dade County, Fla. He testified on behalf of NACDS before the United States House of Representatives Small Business Subcommittee on Investigations and Oversight.
The topic of the hearing was the Center for Medicare and Medicaid Services’ competitive acquisition program for certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), and its impact on small business.
CMS’ new Competitive Acquisition Program requires pharmacists to obtain additional accreditation and submit to a competitive bidding process in order to continue to sell wheelchairs, diabetic supplies, specialized medications and other health products to Medicare Part B beneficiaries.
The new process was mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, and replaces the current Medicare fee schedule for certain DMEPOS.
The program is currently being implemented in 10 major metropolitan areas, with participants in those markets now required to bid competitively to sell 10 categories of medical equipment and supplies. In 2009, the program will be expanded to 80 of the largest markets, and will expand to additional U.S. markets after that.
Speaking on behalf of retail pharmacy, Navarro told the House panel that having to compete with other DME suppliers in a bidding war—and having to post a proposed $65,000 bond to participate—would drive many community pharmacies out of the Medicare DME business. “Retail pharmacies are the largest providers of DMEPOS services to Medicare patients and are in a unique position to monitor trends in diseases and therapy outcomes,” he told lawmakers. “But some of the provisions of the competitive acquisition program and other rules proposed by CMS for DMEPOS suppliers could prevent pharmacies from effectively serving their Medicare patients.”
In addition, said Navarro, diabetic testing supplies sold at retail pharmacies should not be subject to the competitive acquisition program. Pharmacists can play a central role in the management of chronic diseases such as diabetes, he said, and they should be able to continue providing supplies and guidance to patients.
NACDS president and chief executive officer Steven Anderson praised Navarro for his “tremendous expertise on behalf of chain community pharmacy,” and pledged his group and its members are “committed to ensuring access to diabetes testing supplies and other durable medical equipment for Medicare beneficiaries.”
CMS estimated last year that 90 percent of Medicare Part B suppliers, of which pharmacies represent the largest portion, would seek accreditation and participate in the new competitive bidding process. However, the findings of a survey from the National Community Pharmacists Association disputed that rosy prediction, with only 31 percent of community pharmacies in the 10 metropolitan service areas likely to be impacted by the rule indicating their intention to participate in the new program, according to the pharmacy group.
“Most cited concerns about the financial requirement and administrative burden of the bidding process and accreditation,” NCPA noted. “The initial accreditation is anticipated to take 70 hours to complete at an estimated cost of $7,000 to $17,000.”