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CMS needs fair definition of AMP

BY Rob Eder

WHAT IT MEANS AND WHY IT’S IMPORTANT — When CMS withdrew its proposed AMP rule about a year ago, it should have included the sections pertaining to how federal upper limits were calculated — that is, assuming you are using AMP to come up with those FULs. That’s a pretty good argument for throwing out the draft FULs CMS published last week. How can you solve X plus no less than 175% if you’re not really settled on what X equals?

(THE NEWS: NACDS expresses concerns with new FUL list for pharmacy Medicaid reimbursement. For the full story, click here)

That’s a problem because smaller, independent pharmacies could be facing reimbursement cuts of up to 38% to 44%, according to the National Community Pharmacists Association. And its not just mom and pop shops that lack the buying power of a big chain — according to NCPA, the typical independent’s average acquisition costs are about 25% to 50% higher than the average publicly held pharmacy chain — that would get hurt by all this. "After a comprehensive analysis, one [National Association of Chain Drug Stores] member company found that more than half of the draft FULs were below the pharmacy’s cost to acquire these products from a wholesaler," NACDS noted in a Oct. 21 letter to CMS.

First, CMS needs to settle on a fair definition of AMP is before it can determine the minimum amount it will pay pharmacies to dispense drugs to Medicaid patients. According to analysis conducted by Pembroke Consulting, nearly two-thirds of the drugs published in the original AMP data, were being sold by their manufacturers for less than 25 cents a pill — 175% up 25 cents or less doesn’t add up to what a pharmacy will pay for that pill.

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Walgreens pharmacists to provide resources to Medicare Part D beneficiaries

BY Allison Cerra

DEERFIELD, Ill. — Walgreens is continuing to provide resources to Medicare Part D beneficiaries in order to help them better understand their healthcare options.

Walgreens pharmacists this year are offering a free plan comparison report generated from Medicare’s online plan finder at any of its more than 7,700 locations. The report, Walgreens said, is based on the patient’s current medications, so that patients can choose a plan for the first time or determine if their current plan is still the best fit for their needs. What’s more, the report details each plan’s estimated annual costs, including monthly premiums, branded and generic co-pays and coverage through the coverage gap. Medicare beneficiaries also should ensure their pharmacy of choice is in their plan’s network, the drug store chain said.

Patients interested in receiving a report now can schedule appointments for a Medicare Part D plan review at their local pharmacy or at Walgreens.com/medicare. Pharmacists also are available to review plans on a walk-in basis and nearly 4,000 Walgreens stores nationwide will host representatives from Medicare Part D plans, who will provide information and can help people enroll in plans that best fit their needs.

“There are substantial savings available to Medicare Part D beneficiaries this year, so it’s important they know their options to realize these benefits,” Walgreens group VP pharmacy operations Suzanne Hansen said. “Our pharmacists are among the most trusted and accessible sources for help with making an informed plan choice. They can’t decide for you, but they can certainly be a resource to help you understand your options.”

Medicare enrollees have until Dec. 7 to review their coverage options for 2012, Walgreens noted.


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House members send letter to FTC criticizing Express Scripts-Medco merger

BY Alaric DeArment

ALEXANDRIA, Va. — A number of members of Congress have raised questions about the proposed merger between pharmacy benefit managers Express Scripts and Medco Health Solutions, prompting a lobbying group that represents independent pharmacies and opposes the merger to highlight the matter.

The National Community Pharmacists Association pointed to a letter sent Monday to the Federal Trade Commission by 14 Democratic and Republican House members expressing misgivings about the $29.1 billion merger and requesting a "full and thorough investigation." Express Scripts and Medco are 2-of-the-3 largest PBMs in the country, and many political and other leaders have expressed concerns about the effect their merger would have on the PBM market. Meanwhile, the two PBMs have defended the deal, saying it would reduce healthcare spending for payers and consumers.

"On its face, the merger demonstrates the potential for a combined entity to demonstrate an already heavily concentrated market," the representatives wrote. "We understand that this combined entity has the potential to control more than 40% of annual prescriptions and more than 80% of private plans. And, if unregulated, would have the ability to raise prices and/or block pass-through pricing for plans and patients — ultimately limiting critical access."

The 14 representatives who signed the letter were Robert Anderholt, R-Ala.; Spencer Bachus, R-Ala.; Joe Bonner, R-Ala.; Mo Brooks, R-Ala.; Judy Chu, D-Calif.; Maurice Hinchey, D-N.Y.; Ruben Hinojosa, D-Texas; Tom Marino, R-Pa.; Cathy McMorris Rogers, R-Wash.; Mike Rogers, R-Ala.; Martha Roby, R-Ala.; Terri Sewell, D-Ala.; Peter Welch, D-Vt.; and Don Young, R-Alaska.

"The U.S. Congress is clearly taking a much-needed and forceful role in favor of rigorous oversight of the proposed Express Scripts-Medco merger, clouding the once-certain forecasts of the deal’s approval," NCPA CEO B. Douglas Hoey said. "Legislative time is at a premium, so these two hearings represent a major statement of congressional concern over this merger. These developments also demonstrate NCPA’s tireless and coordinated efforts in opposition to the merger."

 


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