PHARMACY

CMS warns against protocol violations of Medicare Part D prescription transfers

BY Michael Johnsen

BALTIMORE — The Centers for Medicare and Medicaid Services earlier this month released a memo to all Part D sponsors, warning them that the agency has "observed an increase in beneficiary complaints related to the transfer of prescriptions from retail pharmacies to either mail-order or specialty pharmacy without their explicit consent."

According to the memo, the transferring of a prescription from one pharmacy to another that is not initiated by the patient is prohibited without the patient’s consent. Unsolicited phone calls made by the plan or pharmacy seeking permission from beneficiaries to transfer a prescription are not permitted.

Also not permitted is the use of prior authorization forms. "The use of other mechanisms, such as prior authorization forms, to steer a beneficiary into a mail-order pharmacy is against CMS requirements and should be discontinued immediately," wrote Cynthia Tudor, director CMS’ Medicare Drug Benefit and C & D Data Group. "The choice of which network pharmacy to use is at the sole discretion and convenience of the beneficiary."

"This action by CMS is a step in the right direction," noted Kevin Schweers, SVP public affairs for the National Community Pharmacists Association, in a blog posted Wednesday. "Hopefully, the agency continues to take this issue seriously and applies greater oversight in the future."

In December, NCPA communicated to CMS possible abuses of the protocol Part D plans must follow to document a patient’s affirmative decision to switch from one pharmacy to another. In a letter to CMS, NCPA noted: "We have learned that a number of Part D plans across the country are calling and harassing beneficiaries to transfer their prescriptions to a preferred network pharmacy (most commonly a mail-order pharmacy). These plans repeatedly call beneficiaries to make the change. Some plans are even moving patients to mail order without telling them, such that the patient fills a prescription at their community pharmacy and receives a duplicate prescription in the mail.”

For Schweers’ full blog post, click here.

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PHARMACY

CVS Caremark study: Focus on Rx adherence saved PBM clients $2.4B in 2011

BY Antoinette Alexander

WOONSOCKET, R.I. — CVS Caremark has aggressively set its sights on enhancing medication adherence, and the initiatives are paying off as the company estimates that its PBM clients saved nearly $2.4 billion in 2011 because of improved medication adherence for chronic conditions, according to findings of its annual Insights Report.

The report, released on Wednesday, reviews drug trend and highlights key issues in pharmacy care. 

The report also found that, in 2011, the drug trend for the company’s PBM employer clients (2.1%) and health plan clients (2.2%) represented the company’s lowest recorded trend for the past seven years.

"Over the past several years, CVS Caremark has conducted research on the causes and impact of medication nonadherence, and we know that taking medications for chronic diseases as directed keeps patients healthier and helps avoid extra costs associated with nonadherence," stated Troyen Brennan, EVP and chief medical officer of CVS Caremark. "Based on our research, we have implemented programs to help our customers and members improve their adherence, and in 2011, the results of these programs increased optimal adherence rates for our clients, resulting in nearly $2.4 billion in overall healthcare savings across our book of business."

"Last year, even consumers with insurance continued to feel the impact of a sluggish economic recovery and responded by rationing their healthcare spending, resulting in relatively flat utilization of pharmacy services," added Per Lofberg, president of CVS Caremark’s PBM business. "As a company focused on helping people on their path to better health, we worked closely with our clients to find opportunities to control costs through formulary management and increased utilization of generic drugs while also continuing to promote programs to improve medication adherence and keep members healthy."

During 2011, the generic dispensing rate for the company’s book of business grew to 74.1% because of the combination of a stream of patent expirations for blockbuster branded drugs and the company’s implementation of formulary and plan design strategies to encourage the use of cost-effective generic drugs.

Another trend driver in 2011 was continued growth in the utilization of complex specialty pharmaceuticals. CVS Caremark’s book of business analysis showed that while specialty drugs may make up as little as 2.5% of a payer’s total prescriptions, they can add up to 31% of overall pharmacy spend. Over the next few years, the impact of specialty medications on pharmacy spend will continue to grow as more specialty drugs enter the market and higher cost per unit prices continue. In 2011, specialty drug trend ranged from 16.5% for employer clients to 19.1% for our health plan clients.

Drug price also was one of the largest drivers of trend in 2011 for CVS Caremark commercial clients, with average wholesale price per day trend showing price increases across both specialty and nonspecialty branded drugs. In fact, since 2007, brand-drug price inflation has increased 27%, the company stated. CVS Caremark noted that it takes these types of market developments into account when developing its formulary and plan design strategies, which promote the use of generic drugs whenever possible and provide for the appropriate use of single-source brand drugs when necessary. CVS Caremark stated that it works with clients to address the impact of price and drug mix by implementing narrower formularies, dispense-as-written penalties and step therapy plan designs to help promote the use of clinically appropriate and cost-effective medications.

The cost savings because of improved adherence was calculated using the company’s pharmacy care economic model, which enables CVS Caremark to calculate the financial value of improved pharmacy care by taking a holistic approach and reviewing adherence, gaps in care and use of generic alternatives. The company’s pharmacy care programs, such as Pharmacy Advisor for diabetes, are succeeding in moving a significant portion of PBM members to optimal levels of medication adherence. The savings calculated using the PCEM are because of medical cost avoidance, drug cost savings and productivity loss avoidance.

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NACDS emphasizes to Senate committee value of community pharmacy

BY Antoinette Alexander

ALEXANDRIA, Va.  — The National Association of Chain Drug Stores has emphasized the commitment of NACDS and the chain pharmacy industry to partner with policy-makers and others to improve quality and lower costs in the healthcare delivery system in a statement sent to the U.S. Senate Health, Education, Labor and Pensions Committee, NACDS announced on Tuesday.

The committee held a hearing on Tuesday titled “Identifying Opportunities for Health Care Delivery System Reform: Lessons from the Front Line.” In its statement, NACDS illustrated the value of community pharmacies in helping to improve patient health and lower healthcare costs through medication therapy management.  
 
“Community retail pharmacies are at the front line in the healthcare system, interacting with patients on a daily basis,” NACDS said in its statement to the committee. “Community pharmacists are uniquely qualified through their comprehensive education and training to significantly reduce the problem of poor medication adherence. We are convinced that [medication therapy management] is a key way to vastly improve health outcomes and reduce costs by ensuring that individuals receive the maximum health benefit from their prescription medicine.”
 
NACDS also emphasized the importance of efforts to expand the ability of pharmacists to administer vaccinations in the Medicare Part D program and increase the utilization of generic drugs as additional ways to improve health and reduce costs.  
 
“Currently all 50 states allow pharmacists to provide certain immunizations. Encouraging Medicare beneficiaries and others to obtain vaccinations at their neighborhood pharmacy is a cost-effective and convenient way to prevent illness and reduce healthcare costs,” NACDS stated. “Pharmacies have long promoted generic drugs as safe, cost-effective alternatives for many patients. Community pharmacy has a higher rate of generic dispensing — 73% — than any other practice setting.”
 
“NACDS thanks the committee for allowing us to share our comments on the role of community pharmacies in improving patient care and reducing healthcare costs through healthcare delivery system reform,” NACDS concluded in the statement.

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