NACDS, NCPA in joint statement praise CMS’ move to withdraw provisions of AMP rule currently blocked by injunction
ALEXANDRIA, Va. National Association of Chain Drug Stores president and CEO Steve Anderson and National Community Pharmacists Association acting EVP and CEO Douglas Hoey issued a statement praising the proposed rule by the Centers for Medicare and Medicaid Services that would withdraw existing provisions of the Medicaid pharmacy reimbursement formula under the average manufacturer price model.
"We are pleased that the Centers for Medicare and Medicaid Services has proposed a rule that would withdraw provisions of what is known as the Medicaid average manufacturer price rule. The proposed rule calls for the withdrawal of existing provisions that define AMP, that determine the calculation of federal upper limits, and that define ‘multiple source drug.’ Put simply, all of these provisions relate to the reimbursement to pharmacies for generic Medicaid prescriptions, and thus impact patients’ access to pharmacies. The move to withdraw these provisions is a victory for patient care as it is delivered in America’s pharmacies every day."
"When we filed the lawsuit in 2007 we knew that patient care was at stake. It is important to point out that the withdrawal of these provisions is another step toward reducing what would have been major cuts to pharmacy reimbursement. The end result is not an increase in reimbursement to pharmacy, but rather the lessening of cuts that previously would have involved pharmacies selling most generic drugs at a loss, thereby threatening their long-term ability to provide patient care."
“We insisted that this policy was not appropriate. Separately, we also have urged that policy-makers should recognize the ability of pharmacies and pharmacists to help improve health and reduce healthcare costs. We are gratified that this sense is reflected in the pharmacy provisions of the new healthcare-reform law. The new law contains provisions ranging from dramatically reducing the AMP cuts to advancing medication therapy management, through which pharmacists can help patients take their medications correctly. … The costs related to poor medication adherence have been estimated to reach $290 billion annually, or 13% of all healthcare expenditures. We urged that patient care should not be jeopardized, but rather that pharmacy be engaged more strategically for the good of patient health and healthcare delivery."
“We anticipate issuing formal comments on CMS’ proposed rule to withdraw these provisions of the AMP rule, and we will continue to work with Congress and with CMS to advocate for access to pharmacy services for patients.”
Once again, study results underscore need for broader role of pharmacy
WHAT IT MEANS AND WHY IT’S IMPORTANT Add another plank to the increasingly solid platform that supports pharmacy’s long-standing fight for a full seat at the healthcare table.
(THE NEWS: ASHP: Healthcare teams with pharmacists improve patient care. For the full story, click here)
Anew health-outcomes study — this one from the American Society of Health-System Pharmacists — yet again demonstrates the unmet potential of community pharmacy as its leaders work to convince policy-makers and health plan payers that pharmacists can do far more than dispense drugs, provide basic counseling and monitor drug interactions. When published in the October edition of the journal Medical Care, the study will add to the growing mountain of evidence supporting pharmacy’s longstanding argument that it brings improved patient outcomes and real cost savings to a fractured healthcare system in dire need of solutions.
The ASHP study, called “US Pharmacists’ Effect as Team Members on Patient Care: Systematic Review and Meta-Analyses,” analyzed the impact on patient health and safety of numerous interventions by pharmacists. Researchers cast a wide net, tracking the results of dozens of pharmacy-care initiatives by reviewing nearly 300 articles and professional papers on the topic.
It was a worthwhile documentation project. Looking at the overall impact of pharmacist interventions and integrated-care programs from the 30,000-ft. level, ASHP found a clear pattern: Community pharmacists working in concert with other members of a patient’s healthcare team can make a big difference in healthier patients and reduced health costs.
One example: An analysis of those many interventions and disease-management efforts found that patients who worked with their pharmacist were 47% less likely to suffer an adverse drug event. And early 90% of studies tracking pharmacists’ impact on managing hemoglobian A1c showed favorable results.
Industry leaders at last week’s National Association of Chain Drug Stores 2010 Pharmacy and Technology Conference made impassioned pleas on behalf of a broader role for pharmacy in a new, reformed U.S. healthcare system. Among them was NACDS president and CEO Steve Anderson, who noted that the pharmacy profession and industry are undergoing a “historic paradigm change” as pharmacists and pharmacy leaders expand their patient-care and clinical capabilities and provide new solutions to a “broken” healthcare system undergoing rapid change.
Also issuing a call to action at the San Diego event was NACDS chairman and CVS/pharmacy president Larry Merlo. “We must ensure that the value of the pharmacy industry and its pharmacists are recognized by payer reimbursement policies — not just for the products we sell but for the services we provide,” Merlo told NACDS members. “We’re positioned to help control the costs of health care by advocating for the value of … pharmacy care.”
Cost of health care on the rise
WASHINGTON Workers on average are paying nearly $4,000 this year toward the cost of family health coverage — an increase of 14%, or $482, above what they paid last year, according to the benchmark "2010 Employer Health Benefits Survey" released Thursday by the Kaiser Family Foundation and the Health Research and Educational Trust.
The jump occurred even though the total premiums for family coverage, including what employers themselves contribute, rose a modest 3% to $13,770 on average in 2010, the survey found. In contrast, the amount employers contributed for family coverage did not increase.
Since 2005, workers’ contributions to premiums have gone up 47%, while overall premiums rose 27%, wages increased 18% and inflation rose 12%.
Many employers also are raising the annual deductibles workers must pay before their health plans begin to share most healthcare costs. A total of 27% of covered workers now face annual deductibles of at least $1,000, up from 22% in 2009, the survey found. Among small firms (three to 199 workers), 46% face such deductibles.
“With the economy struggling, businesses have been shifting more of the costs of health insurance to workers through premiums, deductibles and other cost-sharing,” Kaiser president and CEO Drew Altman stated. “This may be helping to stem the rapid rise in premiums that we saw in the early 2000s, but it also means employer coverage is less comprehensive. From a consumer perspective, the cost of health insurance just keeps going up faster than wages.”
“High out-of-pocket expenses and premiums affect healthcare decisions for patients," added Maulik Joshi, president of the Health Research and Educational Trust and SVP research at the American Hospital Association. "If premiums and costs continue to be shifted to consumers, households will face difficult choices, like forgoing needed care, or reexamining how they can best care for their families,”
The nation’s recession contributed to the shift in burden to workers. In response to the economic downturn, 30% of employers said they reduced the scope of health benefits or increased cost sharing, and 23% reported increasing the amount employees pay for coverage, the survey found.
Among other plan types, only such consumer-driven plans as a health savings account, which allows for the reimbursable purchase of over-the-counter medicines in addition to prescriptions and other healthcare services, saw growth in their market share. Such plans now enroll 13% of covered workers, up from 8% last year.
“Consumer-driven plans have clearly established a foothold in the employer market, tripling their market share from 4% in 2006 to 13% today,” said study lead author Gary Claxton, a Kaiser VP and director of the Healthcare Marketplace Project.
About three-fourths (74%) of employers offering health benefits offered at least one of the following wellness programs: weight-loss program; gym membership discounts or on-site exercise facilities; smoking-cessation program; personal health coaching; classes in nutrition or healthy living; Web-based resources for healthy living; or a wellness newsletter.
Also among firms offering coverage, 11% gave their employees the option of completing a health risk assessment to help employees identify potential health risks. Within this group, 22% (2% of all employers) offer such financial incentives as lowering the worker’s share of premiums or offering merchandise, gift cards, travel or cash to their workers. Large firms are more likely than small firms both to offer assessments and to offer financial incentives.