Indie pharmacy applauds move in Congress to end aggressive Part B recoupment efforts
ALEXANDRIA, Va. The independent pharmacy lobby is hailing a new effort by congressional Democrats to shield owner-operated pharmacies from burdensome financial obligations stemming from years of service to patients covered by Medicare Part B.
Reps. Tammy Baldwin, D-Wis., and Bart Stupak, D-Mich., have called on the Centers for Medicare and Medicaid Services to end what they claim are overly aggressive efforts by agency contractors to recoup monies paid to independent drug stores that supplied and served Part B beneficiaries over the past several years. In a letter, the lawmakers demanded that CMS use its authority to end the aggressive dunning of pharmacies for full-price reimbursements for those past services.
The agency, said Baldwin and Stupak, should “immediately instruct all Medicare Part B durable medical equipment Medicare administrative contractors to cease their recoupment activities for services provided and billed in good faith by independent pharmacies.”
If successful, the bid by Baldwin and Stupak will end efforts by those contractors to recoup from independent pharmacies the entire cost of supplies — such as diabetes testing strips — that were provided to Medicare patients under the Part B program. According to the National Community Pharmacists Association, contractors are trying to extract full payment for supplies provided by pharmacies as far back as 2006, “despite Medicare Advantage and Home Health Agency bearing responsibility for the payment discrepancy.”
The issue has raised a simmering dispute between retail pharmacy and the federal government. It was raised earlier this year in a joint letter to CMS from the National Community Pharmacists Association, the National Association of Chain Drug Stores, and the National Alliance of State Pharmacy Associations. In a statement Thursday, NCPA EVP and CEO Bruce Roberts praised Baldwin and Stupak “for their leadership on this issue” and accused DME contractors of “being intrusive and unrealistic in demanding pharmacies go back several years to account for the supposed overpayment of Medicare Part B supplies.”
“Either patients were getting Part B supplies in the middle of a prescription cycle before they signed up for an MA or HHA, or the patients got the Part B supplies while CMS was processing their application for MA or HHA coverage,” Roberts said. “In either scenario the fault does not lie with pharmacists. Part B claims do not happen in the rapid-fire, coordinated fashion of other programs like Medicare Part D. Instead, pharmacists must rely on getting information from their patients concerning any changes to their prescription drug coverage, which can be confusing and cause further delays.”
“That’s why the DME contractors need to target MA or HHA in their collection efforts and not the pharmacists,” said NCPA’s top executive, who is retiring later this month after nearly nine years at the organization’s helm.
Stater Bros. continues fundraising efforts for blood cancers
SAN BERNARDINO, Calif. Stater Bros. is partnering with The Leukemia & Lymphoma Society for three weeks in June to raise funds for leukemia, lymphoma and Hodgkin’s disease, the California-based grocer said Wednesday.
All 167 Stater Bros. locations will be participating in the fundraising campaign, which will offer customers the opportunity to purchase $1 paper balloons. The proceeds will benefit The Leukemia & Lymphoma Society. Last year, Stater Bros. raised more than $300,000 for the organization — 2010 marks the third year for the partnership.
“The Stater Bros. supermarket family is very happy to be able to give back because there are so many people who have been affected by blood cancers and it is imperative that we join in the fight to find a cure,” stated Jack Brown, chairman and CEO of Stater Bros. “We do not just do business in a community, we are part of each and every community we serve.”
Abbott, Neurocrine Biosciences to commercialize elagolix
ABBOTT PARK, Ill. Two drug makers will work together to develop a drug for the treatment of endometriosis, a condition estimated to affect 100 million women around the world.
Abbott and Neurocrine Biosciences said they would develop and commercialize the drug elagolix, which recently finished a mid-stage study as a treatment for endometriosis and also is under development as a treatment for uterine fibroids. Endometriosis causes chronic pelvic pain throughout the menstrual cycle and dysmenorrhea, pain associated with mestruation. Uterine fibroids are benign tumors that form on the wall of the uterus.
“Extensive preclinical and clinical experience with elagolix suggests this drug could be an important advance for women with endometriosis and uterine fibroids, highly prevalent conditions where there is a need for new treatments,” Abbott SVP pharmaceutical research and development John Leonard stated. “This agreement enhances Abbott’s late-stage pipeline, with the potential for additional compounds in earlier-stage development.”
Abbott will pay $75 million upfront to Neurocrine while funding ongoing development activities. Neurocrine also will be eligible to receive milestone payments of around $500 million and potential royalties.