NCPA sends second letter addressing CMS’ double-billing of certain enrollment fees
WASHINGTON — The National Community Pharmacists Association last week sent a follow-up letter to the Centers for Medicare and Medicaid Services asking the agency to revisit a decision last month that effectively requires some pharmacies to pay duplicative fee-for-service Medicare enrollment/revalidation fees, according to the association.
The fee in question concerns CMS’ interpretation of a 2010 Affordable Care Act requirement where CMS is requiring Medicare provider/supplier enrollees to pay an enrollment/revalidation application fee twice, if the provider/supplier enrolls or revalidates through both an 855S and 855B enrollment/revalidation form for services or items, such as vaccinations and diabetes supplies. "These fees hit small independent pharmacies disproportionately who are already overly burdened in Part B by excessive accreditation fees, aggressive audits, and low payments," NCPA’s SVP government affairs John Coster wrote. "Pharmacies are simply at the breaking point with these additional dual revalidation fees," he added.
"CMS is in plain violation of the ACA statutory requirement on application fees and should revise the relevant regulation to require each institutional provider to pay a single application/revalidation fee, regardless of whether or not that provider has enrolled or revalidated using multiple 855 forms."
NCPA, along with the National Association of Chain Drug Stores, the Food Marketing Institute and the American Pharmacists’ Association, originally sent a letter addressing the situation in November 2011. CMS replied to that letter Jan. 19.
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NACDS endorses ‘The Online Pharmacy Safety Act’
ALEXANDRIA, Va. — The National Association of Chain Drug Stores on Tuesday expressed support for H.R. 4095, “The Online Pharmacy Safety Act,” which the organization said will help consumers protect themselves against the growing threat of illegitimate online drug sellers.
NACDS sent a letter in support of the bill to its sponsors, Reps. Bill Cassidy, R-La., and Mike Ross, D-Ark. The bill requires the Department of Health and Human Services to create a public registry of law-abiding online pharmacy websites for consumer use.
“Your legislation takes important steps to protect the American public from unscrupulous Internet drug sellers that prey on unsuspecting Americans by posing as legitimate pharmacies and deceptively selling counterfeit, adulterated or misbranded medicines,” NACDS stated in its letter to the lawmakers.
The legislation “will provide Americans with the means to protect themselves against this growing threat by ensuring they have the resources they need to recognize safe and legitimate online pharmacies,” NACDS stated.
Research indicates that approximately 17% of Americans — more than 36 million consumers — have purchased medication online without a valid prescription. Research also shows that up to 96% of the online prescription drug websites that U.S. consumers encounter are these illegitimate sites.
“We thank you for your strong commitment to protecting the health and safety of the American public through this thoughtful bill. As Congress continues to debate issues related to prescription drug safety, distribution and access, we believe that the ‘Online Pharmacy Safety Act’ should be an integral part of that discussion and that its enactment should be a top priority,” NACDS stated in its letter.
NACDS also supports companion bipartisan Senate legislation sponsored by Sens. Dianne Feinstein, D-Calif., and Jeff Sessions, R-Ala.
I can't believe some people would care so little for the human life to sell fake drugs to sick people, it's unbelievable! And here I was thinking that securing information is more than enough to deal with internet threats, I guess you need more to keep the scammers at bay. Hopefully the law change will be enough to protect us...
Study finds ‘substantial’ differences between older, younger patient groups
PARSIPPANY, N.J. — Lowering health costs will require a greater understanding of differences between two distinct groups of patients, according to a new study, which also noted a growing availability of specialty drugs for complex and chronic conditions outside the hospital.
The IMS Institute for Healthcare Informatics, part of IMS Health, said Tuesday that policy-makers, payers and healthcare industry players looking to reduce the growth in healthcare costs would have to understand the "substantial" differences in spending and utilization between patients younger than 65 years old with private insurance and those ages 65 years and older with Medicare.
"As states look to define their essential health benefits packages, a deeper understanding of actual utilization patterns, especially for the small number of patients driving the lion’s share of costs, is critical," institute executive director Murray Aitken said. "Further, effective benefits packages will need to fully consider services used by the three high-cost member segments — those with cancer, chronic conditions and those with autoimmune or other specialty diseases."
The study, titled "Healthcare Spending Among Privately Insured Individuals Under Age 65," found that those in the younger group would remain the dominant part of the payment system despite expected changes in the healthcare landscape brought about by the Affordable Care Act. Meanwhile, differences in variables, such as care setting and treatment use result in a different distribution of costs across inpatient, outpatient and pharmacy services. Among those in the younger segment, outpatient and inpatient services represented 59% and 20% of total spending, respectively, compared with 39% and 43% for those older than 65 years old.
Pharmacy spending represented 21% of overall health spending, with health plan members with chronic conditions filing 78% of all prescriptions and specialty drugs accounting for 17% of retail pharmacy spending. Overall, the report found, spending on specialty drugs accounted for 6% of all spending by health plan members, while pharmacy spending represented 33% of the total for members with autoimmune and other specialty conditions. The report noted that this reflected a growing availability of drugs for specialty conditions that could be administered outside the hospital.
The report also indicated that those in the younger group who were among the top 1% in annual spending were "vastly" disproportionate users of healthcare resources, spending an average of nearly $100,000 annually per member on health services, compared with the $3,837 per member spent by the overall plan population. Among members of this group, 77% were diagnosed with at least one chronic condition, while 16% had at least one cancer. The top 20% of members with the greatest need for healthcare services were responsible for more than 80% of total healthcare spending.
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