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NCPA survey challenges MAC, audits

BY Michael Johnsen

Abusive auditing and unfair reimbursement practices harm community pharmacists’ ability to provide critically needed patient counseling and care to seniors, according to a new survey released Sept. 18 by the National Community Pharmacists Association.


NCPA polled more than 350 community pharmacists about their recent experience with audits conducted by pharmacy benefit managers and other Medicare Part D plan intermediaries. The survey also asked about generic drug reimbursement caps known as maximum allowable costs, or MACs. 


Among the findings:


  • 96% stated that a typical PBM contract has minimal or no transparency on how generic pricing is determined or what the reimbursement rate will be;


  • Almost 50% of respondents said that more than 10% of the time, PBMs set MAC reimbursement for generics below the pharmacy’s cost of simply acquiring the drug, much less dispensing and overhead costs, and 92% said payments are not increased promptly to reflect a drug’s rising market costs;


  • 3-in-4 pharmacists said audit requirements across Medicare Part D plans are not consistent, increasing their compliance burden; and


  • Nearly 87% stated that PBM reimbursement and auditing practices are “significantly” or “very significantly” affecting their ability to provide patient care and remain in business.


When asked which drugs had MAC limits set below the pharmacy’s cost of acquiring the product, more than 600 drugs were identified, including budesonide (for asthma); atorvastatin (cholesterol); clarithromycin (antibiotic); fentanyl patches (pain); hydrocodone (pain/inflammation); and methylprednisolone (steroid for allergic reactions, skin conditions and breathing disorders).

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ReportersNotebook — Chain Pharmacy, 10/15/12

BY DSN STAFF

SUPPLIER NEWS — The Food and Drug Administration has approved a drug made by Acton Pharmaceuticals for asthma, the company said. The drug maker announced the approval of Aerospan (flunisolide HFA) inhalation aerosol as a maintenance treatment for asthma in patients ages 6 years and older. The drug maker plans to launch the drug in early 2013. Asthma affects more than 24 million Americans, according to the Centers for Disease Control and Prevention, and healthcare market research firm IMS Health estimated the market for inhaled steroids to be worth $8.3 billion.


Drug maker Vivus has released what it called the first new drug in 13 years for chronic weight management in adults. The company announced the availability of Qsymia (phentermine and topiramate) extended-release capsules, which it is formally introducing to medical professionals at the Obesity Society’s annual scientific meeting in San Antonio. The drug, which is classified as a schedule IV controlled substance by the Drug Enforcement Administration, has a risk evaluation and mitigation strategy, or REMS. In addition to a medication guide, healthcare provider training, patient brochure and other educational materials, the drug is only available through certified mail-order pharmacies that are part of the Qsymia Home Delivery Network, including CVS Pharmacy and Walgreens.


A subsidiary of Johnson & Johnson is hoping to gain FDA approval for a new formulation of one of its drugs. Janssen Biotech announced that it had filed an application with the FDA seeking approval for an intravenous formulation of Simponi (golimumab) in adults with moderately to severely active rheumatoid arthritis, which affects an estimated 1.5 million Americans. The FDA approved the subcutaneously injected formulation of Simponi in April 2009 for moderately to severely active rheumatoid arthritis, active psoriatic arthritis and active ankylosing spondylitis.

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FlavoRx: Taste of meds boosts loyalty

BY Alaric DeArment

A two-part study by the Temple University School of Pharmacy and market research firm WilsonRx found the availability of custom flavoring for children’s medications boosted customer satisfaction and loyalty. The study, consisting of an intercept survey of 200 mothers at Philadelphia and 
New Jersey drug stores and a review of a WilsonRx mail survey of 34,454 customers, found that 50% of parents were very or extremely likely to recommend a pharmacy that actively informed them about flavoring services, while 7% were not. 


At the same time, 52% of respondents to the survey said they didn’t know whether their pharmacies offered the services, compared with 6% who said their pharmacies didn’t offer them and 42% who said they did. Meanwhile, according to medication flavoring maker FlavoRx, only 3% of medications that can have flavoring added actually do.


But those stores without flavoring or that don’t promote it could be seriously missing out. The study found that a store could gain 16 to 24 new customers per year and generate between $51,000 and $78,000 in new business by promoting a custom-flavoring service.


The line in “Mary Poppins” about “just a spoonful of sugar” contains a grain of truth. According to the intercept survey, 79% of children complained about medication tasting too bad to take, and about 85% of interviewed subjects said the taste of liquid medicine is somewhat or very important to them and to their children.

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