Medicaid plans to end onerous AMP rules
WHAT IT MEANS AND WHY IT’S IMPORTANT It’s about time.
(THE NEWS: NACDS, NCPA in joint statement praise CMS’ move to withdraw provisions of AMP rule currently blocked by injunction. For the full story, click here)
The White House, or more specifically the Centers for Medicare and Medicaid Services’ division of Health and Human Services, announced in recent days that it plans at last to scrap its controversial and burdensome pricing policies for generic drugs bought by retail pharmacies to dispense to Medicaid patients. If CMS’ newly proposed rule goes through, it will mean the end of the current, much-disputed provisions that define the average manufacturer price of Medicaid me-too medicines.
The proposed rule, to quote the National Association of Chain Drug Stores, calls for “the withdrawal of existing provisions that define AMP, that determine the calculation of federal upper limits [FULs], and that define ‘multiple source drug.’”
As currently defined, Medicaid’s payment model for reimbursing pharmacists to dispense generics is based on a flawed formula for determining what retail pharmacies pay for those medicines, as determined by a set of controversial market metrics.
The current AMP policy almost is a guarantee that retail pharmacies would lose money on nearly every Medicaid generic prescription they dispense. It’s only a temporary court injunction that has thus far kept that new formula from being imposed.
Thus, CMS’ turnabout marks a real victory for the chain and independent pharmacy lobby, which has bitterly contested the AMP reimbursement formula since it was made policy by the Bush administration more than three years ago. But the plan to withdraw the current AMP model doesn’t end the long battle by pharmacy for a fair payment policy for dispensing generic drugs to Medicaid beneficiaries.
What the pharmacy industry –– and the U.S. healthcare system itself, for that matter –– need is a permanent solution to the Medicaid reimbursement mess. And that solution can only be achieved by congressional action and enactment of a new law governing Medicaid.
The 2010 health-reform law goes part way toward that solution, by holding the line on pharmacy cuts and setting the FULs on Medicaid prescription payments at no less than 175% of cost. It also includes what NACDS president and CEO Steve Anderson calls “a much-improved definition and calculation method for AMP” that will “better approximate pharmacies’ costs for purchasing generic drugs.”
Anderson said the injunction lawsuit filed in 2007 by NACDS and its independent pharmacy counterpart, the National Community Pharmacists Association, has saved pharmacy more than $5.3 billion in cuts since a federal court blocked the imposition of the new AMP formula in January 2008. It also may have prevented the closing of more than 11,000 community pharmacies that otherwise would have been forced to dispense Medicaid scripts at a loss or stop serving lower-income patients.
“When we filed the lawsuit in 2007, we knew that patient care was at stake,” Anderson asserted.
The bottom line is that the White House and Congress need to establish a federal payment system that rewards –– rather than penalizes –– pharmacies for dispensing lower-cost generics that provide the same safety and efficacy profiles as higher-cost pioneer medicines. Such a permanent fix would be a win both for the pharmacy industry and the American taxpayer, by saving tens or even hundreds of billions of dollars over the long term in federal health costs.
Active phone prompts spur Rx adherence rates among consumers, CVS reveals
WOONSOCKET, R.I. Consumers are much more likely to adhere to their prescription medication therapy if given “a clear and active choice” in recorded telephone prompts from their pharmacy, new research into patient compliance from CVS Caremark demonstrated.
The company announced Thursday the results of a long-term research project into patient behavior, conducted by its Behavior Change Research Partnership. Those findings, presented at a Pittsburgh Business Group on Health symposium, underline a clear connection between encouraging patients to get their maintenance medications refilled and improved adherence rates.
“Ongoing research into how behavioral economics impacts healthcare choices found that when consumers are presented with a clear and active choice in a voice-recorded message to select automatic prescription refills, rather than a passive default notification, they are twice as likely to choose the automatic option,” CVS said.
CVS established the BCRP in March to study how behavioral economics impacts consumer healthcare decisions. The research group also was created “to help the company better understand why some patients stop taking maintenance medications for chronic illnesses,” the company noted.
The research results were presented by Troyen Brennan, CVS Caremark EVP and chief medical officer. “The preliminary findings show that by making choices clear and by streamlining messages, consumers sign up at twice the rate of those who are passively presented opt-in choices,” Brennan told Pittsburgh business leaders Thursday. “This research will help us develop programs to encourage people to stay on their medications, because nonadherence is costing the healthcare system billions of dollars every year.”
The BCRP research, titled “Active Choice,” is testing options in four communication channels, CVS said. Those channels include interactive Web sign-ins, in-bound customer calls to care centers, automated outbound telephone calls and direct mail.
“The testing shows some options offered to consumers today are overlooked because the choices are not readily transparent,” the company said. “Past industry studies show one-quarter of people receiving prescriptions never fill their first prescriptions, and patients with chronic diseases, such as diabetes and coronary artery disease, adhere to their ongoing medication regimen about half of the time.”
The BCRP panel is led by Punam Anand Keller of the Tuck School of Business at Dartmouth College, George Loewenstein of Carnegie Mellon University and Kevin Volpp of University of Pennsylvania’s Medical School and The Wharton School of Business. The presentation in Pittsburgh continued discussion of BCRP research that was first presented at a Centers for Disease Control and Prevention symposium in Atlanta last month.
SDI: Many Americans have received seasonal flu shot
PLYMOUTH MEETING, Pa. More than 690,000 Americans already have received this season’s flu vaccine from their doctors, according to SDI’s VaccineTrack data through Sept. 4.
VaccineTrack provides syndicated weekly vaccine usage by physicians based on medical office electronic healthcare reimbursement claims data.
The Centers for Disease Control and Prevention recently announced an unprecedented campaign to combat seasonal flu through a universal vaccination strategy. CDC removed many restrictions and currently supports seasonal influenza vaccination for all persons 6 months of age and older based on the recommendation of the Advisory Committee on Immunization Practices, which advises CDC on vaccine issues.
In the 2010-2011 season, vaccine manufacturers are slated to produce more influenza vaccine than ever before. Shipments of influenza vaccine began weeks ahead of most other seasons in anticipation of rapid and wide-ranging vaccine uptake.
“These measures taken by the CDC and vaccine manufacturers facilitate public health efforts to make flu vaccines available to all,” stated Andrew Kress, CEO of SDI.