PHARMACY

NACDS submits comments to CMS regarding Medicaid pharmacy reimbursement provisions of healthcare-reform law

BY Antoinette Alexander

ALEXANDRIA, Va. — The National Association of Chain Drug Stores has submitted official comments to the Centers for Medicare and Medicaid Services regarding its proposed rule on Medicaid pharmacy reimbursement using the average manufacturer price model. The AMP model was reformed by the Patient Protection and Affordable Care Act.

In its comments, NACDS highlighted several areas of concern, including the definition of AMP, retail community pharmacy and wholesaler, when to calculate a federal upper limit, the amount of FULs and the importance of accurate Medicaid dispensing fees.

In its comments, NACDS expressed concern with AMP and its lack of correlation with pharmacy acquisition costs.

“It is important to note that AMP is not a price paid in the marketplace. In fact, analysis of the weighted AMPs published by CMS along with draft FUL lists, as well as government reports, indicate AMP is not a reliable benchmark for pharmacy reimbursement,” NACDS stated.

NACDS also urged CMS to “require states to re-evaluate dispensing fees to assure that they adequately cover costs and to include specific factors on assessing dispensing fees in this rulemaking.”

In addition, NACDS outlined the importance of ensuring that CMS wait until final rulemaking is completed before AMP-based FULs are used for pharmacy reimbursement. CMS has released seven draft FUL lists. According to NACDS, these draft FULs pose concerns for community pharmacy, as there is no regulatory process in place to ensure their accuracy since CMS withdrew the AMP rule in 2007.

“Due to the complexities outlined in our comments, we urge CMS to complete final rulemaking before implementing the pharmacy reimbursement provisions of the Affordable Care Act. We are committed to working with you to implement these provisions in a manner that complies with current law and maintains access to prescription drugs and pharmacy services for Medicaid beneficiaries,” NACDS stated.

The legislative language in the Patient Protection and Affordable Care Act that led to the development of a new proposed rule is a direct result of an important and successful multiyear effort to defend pharmacy patient care, NACDS noted.

NACDS and the National Community Pharmacists Association in November 2007 filed a lawsuit that challenged CMS’ prior implementation of the AMP model in the Deficit Reduction Act of 2005. In December 2007, a federal judge issued a preliminary injunction against that rule. NACDS and NCPA withdrew their lawsuit in December 2010 after CMS formally withdrew provisions of the AMP rule related to the definition of AMP, calculation of FUL and the definition of “multiple source drug.”

Also, NACDS submitted comments to the Office of Management and Budget regarding collection of National Average Drug Acquisition Cost data. In its comments, NACDS outlined several concerns, including the apparent lack of legal authority to collect NADAC, as well as conflicting information in the draft materials on confidentiality. NACDS comments also addressed the importance of comprehensive pharmacy reimbursement.

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Spending on branded, generic drugs increased in 2011, IMS report finds

BY Alaric DeArment

PARSIPPANY, N.J. — People ages 65 years and older reduced their volume of prescriptions, while those ages 19 to 25 years increased their use of prescription drugs as the healthcare-reform law allowed them to remain on their parents’ insurance, according to a new report by IMS Health.

The report, "The Use of Medicines in the United States: Review of 2011," found that per capita spending on U.S. medicines grew by 0.5% as healthcare system spending reached $320 billion and new drug launches opened new treatment options for more than 20 million Americans.

"2011 was a remarkable year for the volume of drug breakthroughs that became available to millions of Americans," IMS Institute for Healthcare Informatics director of research and development Michael Kleinrock said.

The report found that 34 new drug molecules were launched in 2011 — the most in a decade — including first-time treatments for multiple sclerosis, several types of cancer, hepatitis C and cardiovascular conditions. The year also saw the largest number of launches of orphan drugs, which the Food and Drug Administration defines as treating diseases that affect fewer than 200,000 Americans.

"At the same time, some troubling trends that began in 2009 persisted, with many patients appearing to ration their medical care," Kleinrock said. "The implications of fewer doctor visits and lower drug utilization on patients’ health have yet to play out and require further study."

According to the report, the number of doctor office visits declined by 4.7%, while emergency room admissions increased by 7.4%. Retail prescription drug use declined by 1.1%, including a 3% decline in 10 states. While people ages 19 to 25 years increased prescription drug use by 2% — with notable rises in the use of antidepressants and attention deficit hyperactivity disorder — seniors’ use of drugs decreased by 3.1%. The younger age group was the only one whose use of prescription drugs increased.

Meanwhile, total spending on branded drugs increased by 2.2%, while spending on branded drugs launched within the past two years was $12.2 billion in 2011, compared with $8.5 billion in 2010. Spending on generics increased by $5.6 billion, and generics now account for 80% of dispensed prescriptions. Nearly one-third of total healthcare spending was concentrated on cancer, diabetes, dyslipidemia, mental health and such respiratory disorders as asthma and chronic obstructive pulmonary disease.


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CVS/pharmacy’s Rob Price named to 2012 Class of Henry Crown fellows

BY Antoinette Alexander

WASHINGTON — Rob Price, CVS/pharmacy’s SVP and chief marketing officer, has been named to the Aspen Institute’s 2012 Class of Henry Crown fellows.

The Henry Crown Fellowship is designed to engage the next generation of leaders in the challenge of community-spirited leadership. It brings together executives from the business world — all entrepreneurs, all younger than 45 years — who have already achieved conspicuous success in their chosen fields and are at a point of inflection in their lives and careers. Previous Henry Crown fellows have included Deval Patrick, governor of Massachusetts; Michael Powell, former Federal Communications Commission chairman; and Reed Hastings, CEO of Netflix.

“Rob represents the type of leader that we believe has the capacity to make a significant impact on our society,” stated Eric Motley, managing director of the Henry Crown Fellowship. “As you can imagine, we are all the more excited to welcome him into the fellowship of 20 other like-minded individuals.”

“Rob’s appointment to the Henry Crown Fellowship for 2012 speaks to the quality of our leadership at CVS Caremark,” stated Larry Merlo, president and CEO of CVS Caremark. “We’re proud of Rob’s selection for this prestigious program, which is focused on community-spirited leadership.”

At CVS/pharmacy, Price is responsible for advertising, promotion, marketing, customer relations and consumer research, as well as retail innovation and store design, the CVS.com e-commerce business and the ExtraCare loyalty program. He also has been instrumental in the integration of the store and digital environments for CVS/pharmacy.

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